Individual
MATTHEW J BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
455 BRIARGATE DR., SOUTH ELGIN, IL 60177
(847) 622-0506
(847) 622-0507
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-105926
IL
207QS0010X
Sports Medicine (Family Medicine) Physician
036-105926
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105926 3
—
IL
01
—
4532366
BCBS
IL
Enumeration date
11/17/2006
Last updated
08/04/2023
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