Individual
BRENT T. FONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
PROVENA MERCY MEDICAL CENTER / PATHOLOGY DEPARTMENT, 1325 NORTH HIGHLAND AVENUE, AURORA, IL 60506
(630) 859-2222
Mailing address
520 E 22ND ST, LOMBARD, IL 60148-6110
(630) 874-2542
(630) 874-2642
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036088383
IL
Other
Enumeration date
08/11/2005
Last updated
05/13/2008
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