Individual
BRETT STAIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NAVY IDC
Contact information
Practice address
3420 ILLINOIS ST, BHC 1007, GREAT LAKES, IL 60088-3120
(847) 688-7536
Mailing address
3420 ILLINOIS STREET, GREAT LAKES, IL 60088-5230
(847) 688-7536
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1002X
TAXONOMY
IL
Enumeration date
07/26/2007
Last updated
07/26/2007
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