Individual
THOMAS KEVIN BRATTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3322 W WILLOW KNOLLS DR, PEORIA, IL 61614-8148
(309) 691-5800
(309) 691-1336
Mailing address
3322 W WILLOW KNOLLS DR, PEORIA, IL 61614-8148
(309) 691-5800
(309) 691-1336
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007215174
BLUE CROSS BLUE SHIELD
IL
05
—
016003267
—
IL
01
—
480009789
MEDICARE RAILROAD
IL
01
—
928270
MEDICARE PROVIDER NUMBER
IL
Enumeration date
01/16/2006
Last updated
04/03/2008
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