MEDICARE: DR. DENNIS RICHARD BRIGHTWELL M.D.

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
1	2084P0800X	Psychiatry Physician	036103977	IL
2	2084P0800X	Psychiatry Physician	56574-20	WI

General Provider Information

NPI Number	:	1841288420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS RICHARD BRIGHTWELL M.D.

Provider Business Mailing Address
First Line	:	422 TRACY CT
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6288
Country	:	US
Telephone Number	:	815-363-6132
Fax Number	:

Provider Business Practice Location Address
First Line	:	422 TRACY CT
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6288
Country	:	US
Telephone Number	:	815-363-6132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2005
Last Update Date	:	01/15/2016

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