Bockewitz, Brandon

Bockewitz, Brandon is an individual health care provider with primary practice located at 5401 N Knoxville Ave Ste 112 , Peoria IL 61614-5021. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Bockewitz, Brandon can be contacted via phone (309) 693-2020.

Contact Information

Primary practice address
5401 N Knoxville Ave Ste 112 Peoria IL 61614-5021
Phone: (309) 693-2020
Fax: (309) 683-8850
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036121479 Illinois
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 036121479 Illinois

Profile Details

NPI number 1619199627
LBN Legal business name Bockewitz, Brandon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2007
Last updated Jan 7th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619199627 NPPES
Illinois Other 036121479 LICENSE

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