Individual
MERRILEE R BRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1054 MARTIN LUTHER KING DR, SUITE 125, CENTRALIA, IL 62801-3000
(618) 436-5200
(618) 436-8066
Mailing address
1054 MARTIN LUTHER KING DR, SUITE 125, CENTRALIA, IL 62801-3000
(618) 436-5200
(618) 436-8066
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301064187
MI
208600000X
Surgery Physician
Primary
036100456
IL
208600000X
Surgery Physician
0433646
KS
208600000X
Surgery Physician
11827
ND
208600000X
Surgery Physician
2009002719
MO
208600000X
Surgery Physician
27935
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100456
—
IL
Enumeration date
06/14/2006
Last updated
11/17/2020
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