Individual
KENNETH DALE BRANN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2060 W ILES AVE, SUITE C, SPRINGFIELD, IL 62704-4191
(636) 284-4987
Mailing address
2060 W ILES AVE, SUITE C, SPRINGFIELD, IL 62704-4191
(636) 284-4987
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
3118
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3118
ILLINOIS HEARING INSTRUMENT DISPENSER
IL
Enumeration date
11/15/2012
Last updated
10/26/2016
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