Individual
MR. KURT JEFFREY BROTHERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 N WESTMORELAND RD, BLDG B, LAKE FOREST, IL 60045-1679
(847) 482-0136
(847) 482-0302
Mailing address
700 N WESTMORELAND RD, BLDG B, LAKE FOREST, IL 60045-1679
(847) 482-0136
(847) 482-0302
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C42117
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C421170
—
CA
Enumeration date
12/12/2006
Last updated
11/01/2011
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