Brandon Lofthouse
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Spring Grove, IL
NPI 1770944290 · NPPES record last updated Mar 10, 2016
Key facts
- NPI
- 1770944290
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 37819 N Watts Ave
Spring Grove, IL 60081-9324 - Phone
- (224) 639-8519
- NPI assigned
- Mar 10, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
37819 N Watts Ave
Spring Grove, IL 60081-9324
Mailing address
37819 N Watts Ave
Spring Grove, IL 60081-9324
Phone (224) 639-8519
Other providers in Spring Grove, IL
- Adam R Hoevel
- Kenneth Andrew Kaczmarek
- Casey Ketelsen
- Sonia Kwapisinski
- Cindy Leprich-Gort
- Christina Marie Martorano
- Gina Maziarz
- Cathy Lynn McCoy
- Molly Mehlman
- Steffan Matthew Miller
All providers in Spring Grove, IL · Student in an Organized Health Care Education/Training Program in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2016. 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.