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General NPI Number Information
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NPI Number | 1750193355
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Entity Type | Individual
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Provider Name | BRIAN BRISTEN
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Gender | Male
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 335 N MILWAUKEE AVE
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City | VERNON HILLS
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State | IL
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Zip | 60061-1561
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Country | US
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Telephone | 847-883-8360
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Fax |
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Provider Business Mailing Address
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Address Line | 5670 NORTHWEST HWY
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-8017
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Country | US
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Telephone | 847-883-8360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2390
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License Number State | IL
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