Individual
BRANDEN LEE MOSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
2650 RIDGE AVE # 4210, EVANSTON, IL 60201
(847) 570-1010
Mailing address
9977 WOODS DR STE B70, SKOKIE, IL 60077-1057
(847) 663-2655
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.007003
IL
363A00000X
Physician Assistant
PA1713
NV
Other
Enumeration date
02/22/2016
Last updated
06/17/2019
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