Brattain, Thomas Kevin

Brattain, Thomas Kevin is an individual health care provider with primary practice located at 3322 W Willow Knolls Dr , Peoria IL 61614-8148. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Brattain, Thomas Kevin can be contacted via phone (309) 691-5800.

Contact Information

Primary practice address
3322 W Willow Knolls Dr Peoria IL 61614-8148
Phone: (309) 691-5800
Fax: (309) 691-1336
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 016003267 Illinois

Profile Details

NPI number 1285613463
LBN Legal business name Brattain, Thomas Kevin
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 16th, 2006
Last updated Apr 3rd, 2008 - about 16 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 1285613463 NPPES
Illinois Other 0007215174 BLUE CROSS BLUE SHIELD
Illinois MEDICAID 016003267 BLUE CROSS BLUE SHIELD
Illinois Other 928270 BLUE CROSS BLUE SHIELD
Illinois Other 480009789 BLUE CROSS BLUE SHIELD

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