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Individual

BRETT W WOLTERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
800 N 1ST ST, SPRINGFIELD, IL 62702-3719
(217) 528-7541
(217) 522-3118
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036117547
IL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
036117547
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036117547
IL
Enumeration date
06/03/2006
Last updated
05/19/2020
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