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NPI Code Detail

MEDICARE: ELIZABETH M BRANDON DO

MEDICARE: ELIZABETH M BRANDON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician36094475IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
136094475OTHERILLICENSE

General Provider Information

NPI Number : 1659302347
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH M BRANDON DO
Provider Business Mailing Address
First Line : 1870 W GALENA BLVD
Second Line :
City : AURORA
State : IL
Zip : 60506-4356
Country : US
Telephone Number : 630-859-6700
Fax Number : 630-859-6941
Provider Business Practice Location Address
First Line : 4100 HEALTHWAY DR
Second Line :
City : AURORA
State : IL
Zip : 60504-4163
Country : US
Telephone Number : 630-851-3105
Fax Number : 630-978-6669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 03/27/2008

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