Individual
LUKAS DEAN BRASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1089 TAMPICO DR, EDWARDSVILLE, IL 62025-5195
(618) 971-1758
Mailing address
1089 TAMPICO DR, EDWARDSVILLE, IL 62025-5195
(618) 971-1758
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/27/2025
Last updated
02/27/2025
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