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Individual

ELLEN S BRULL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
7900 N MILWAUKEE AVE, NILES, IL 60714-3159
(847) 967-9660
(847) 470-9323
Mailing address
7900 N MILWAUKEE AVE, NILES, IL 60714-3159
(847) 967-9660
(847) 470-9323

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036073311
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01623792
BLUE CROSS BLUE SHIELD
IL
05
036073311
IL
Enumeration date
10/28/2006
Last updated
12/07/2021
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