Suprenant, Brad L

Suprenant, Brad L is an individual health care provider with primary practice located at 500 N Wall St , Kankakee IL 60901-2942. He recently has only one registered license in Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology, which is considered as his primary health care specialty. Suprenant, Brad L can be contacted via phone (844) 404-4787.

Contact Information

Primary practice address
500 N Wall St Kankakee IL 60901-2942
Phone: (844) 404-4787
Fax: (815) 936-3243
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology 207RC0001X 02001098A Indiana
Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology 207RC0001X 036071427 Illinois

Profile Details

NPI number 1760467377
LBN Legal business name Suprenant, Brad L
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 7th, 2005
Last updated Mar 29th, 2021 - about 3 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 1760467377 NPPES
Illinois MEDICAID 036071247
Illinois Other 060030169
Illinois Other 000000095316

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