Individual
DR. BRETT HOWARD HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
1418 CROSS ST, DIV IM MEDICAL ONCOLOGY, STE 180, SHILOH, IL 62269-2914
(618) 607-1340
(618) 622-9724
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(618) 607-1340
(618) 622-9724
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036153509
IL
207RX0202X
Medical Oncology Physician
Primary
036153509
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200063716
—
MO
Enumeration date
06/13/2015
Last updated
04/21/2025
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