Brock, Theodore Craig

Brock, Theodore Craig is an individual health care provider with primary practice located at 304 Randall Rd , Geneva IL 60134. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Brock, Theodore Craig can be contacted via phone (630) 232-0610.

Contact Information

Primary practice address
304 Randall Rd Geneva IL 60134
Phone: (630) 232-0610
Fax: (630) 232-0675
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 209010570 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209010570 Illinois

Profile Details

NPI number 1386070480
LBN Legal business name Brock, Theodore Craig
Credentials APN-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2013
Last updated May 2nd, 2024 - about 6 months 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 1386070480 NPPES
Illinois Other 041303225 MEDICAID
Illinois Other CA4748 MEDICAID
Illinois Other P01349683 MEDICAID
Illinois Other 206147 MEDICAID
Illinois Other F400112507 MEDICAID

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