Organization
PAI PARTICIPANT 27, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTAIN BRANTLEY (ACTING PRESIDENT)
(302) 300-5138
Entity
Organization
Contact information
Practice address
7050 S MADISON ST, WILLOWBROOK, IL 60527-5548
(630) 323-6380
Mailing address
PO BOX 639676, CINCINNATI, OH 45263-9676
(859) 291-4800
(859) 655-8588
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
05/03/2021
Last updated
08/13/2026
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