Individual
BRAD LYN HARTWIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11475 N 2ND ST, MACHESNEY PARK, IL 61115-1285
(815) 654-8000
Mailing address
1394 KIWANIS DR APT B302, FREEPORT, IL 61032-6940
(815) 821-4777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-002982
IL
363A00000X
Physician Assistant
Primary
1167
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42988500
—
WI
Enumeration date
06/16/2006
Last updated
01/16/2008
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