Individual
BRANDON INGALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3313
(217) 383-4014
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
03613460
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/13/2015
Last updated
01/20/2021
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