Individual
MR. THEODORE CRAIG BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN-BC
Contact information
Practice address
304 RANDALL RD, GENEVA, IL 60134
(630) 232-0610
(630) 232-0675
Mailing address
304 RANDALL RD, GENEVA, IL 60134-4200
(630) 232-0610
(630) 232-0675
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209010570
IL
363LA2200X
Adult Health Nurse Practitioner
209010570
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041303225
MEDICAID
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
CA4748
MEDICARE RAILROAD (GROUP)
IL
01
—
F400112507
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P01349683
MEDICARE RAILROAD (INDIVIDUAL)
IL
Enumeration date
09/20/2013
Last updated
05/02/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us