Individual
DR. BRIAN WADE MECKLENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2202 HARLEM ROAD, SUITE 200, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 654-3271
Mailing address
2202 HARLEM ROAD, SUITE 200, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 654-3271
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.149788
IL
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
0101102755
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036149788
—
IL
Enumeration date
02/07/2007
Last updated
01/13/2020
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