Brandon Hargrove
Individual provider Active NPI Driver · Justice, IL
NPI 1245909142 · NPPES record last updated Sep 13, 2021
Key facts
- NPI
- 1245909142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- H62606085086 (IL)
- Practice address
- 425 Sterling St E
Justice, IL 60458-1228 - Phone
- (224) 258-3928
- NPI assigned
- Sep 13, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H62606085086 | IL | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | H62606085086 | IL | Yes |
Addresses
Primary practice location
425 Sterling St E
Justice, IL 60458-1228
Mailing address
425 Sterling St E
Justice, IL 60458-1228
Phone (224) 258-3928
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Direct | Health Information Exchange (HIE) |
Other providers in Justice, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.