Individual
TRACY C BRITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3401 N PERRYVILLE RD, ROCKFORD, IL 61114-8011
(815) 971-2000
(815) 971-9447
Mailing address
3401 N PERRYVILLE RD, ROCKFORD, IL 61114-8011
(815) 971-2000
(815) 971-9447
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
036074111
IL
207R00000X
Internal Medicine Physician
036074111
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400269517
MEDICARE PTAN
IL
Enumeration date
07/11/2006
Last updated
06/02/2016
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