Provider Demographics
NPI:1073663217
Name:BRANDES, BARRY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:BRANDES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 S. CICERO AVE.
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452
Mailing Address - Country:US
Mailing Address - Phone:708-633-2874
Mailing Address - Fax:170-863-3418
Practice Address - Street 1:15900 S. CICERO AVE.
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452
Practice Address - Country:US
Practice Address - Phone:708-633-2874
Practice Address - Fax:170-863-3418
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-002988-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37355Medicare UPIN