Individual
BRYAN MICHAEL MISTRETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
315 W CARPENTER ST, SPRINGFIELD, IL 62702-4901
(217) 545-8000
(217) 545-0952
Mailing address
PO BOX 19638, SPRINGFIELD, IL 62794-9638
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
125076122
IL
208C00000X
Colon & Rectal Surgery Physician
Primary
036174964
IL
Other
Enumeration date
05/25/2020
Last updated
08/07/2026
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