Kurt J Brotherson
Family Medicine in Lake Forest, IL. Organization (NPI-2).
NPI number1609228683
StatusActive
Last updated in NPPESJul 1, 2016
Details
- NPI
- 1609228683
- Entity type
- Organization (NPI-2)
- Legal business name
- Kurt J Brotherson
- Organization subpart
- No
- Enumeration date
- Jul 1, 2016
- Last updated
- Jul 1, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
840 S Waukegan Rd203
Lake Forest, IL 60045-2608
Phone 847-482-0136
Mailing address
840 S Waukegan Rd203
Lake Forest, IL 60045-2608
Phone 847-482-0136
Authorized official
Kurt J Brotherson
Sole Proprietor
8474820136
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