Individual
BRANDON TIMOTHY BAZELUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 KYLE DR, HAVELOCK, NC 28532-1773
(630) 297-6750
Mailing address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/06/2022
Last updated
03/10/2023
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