Individual
DR. PETER T BRAZIS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2105 N. MAIN ST, WHEATON, IL 60187
(630) 668-8250
(630) 668-8916
Mailing address
2105 N. MAIN ST, WHEATON, IL 60187
(630) 668-8250
(630) 668-8916
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
36-052950
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052950
—
IL
01
—
180012223
RR MEDICARE
IL
Enumeration date
10/05/2005
Last updated
03/19/2009
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