Provider Demographics
NPI:1346267895
Name:BRUMMER, JUDY S (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:S
Last Name:BRUMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10874 E 2000TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHUMWAY
Mailing Address - State:IL
Mailing Address - Zip Code:62461-2267
Mailing Address - Country:US
Mailing Address - Phone:217-868-2786
Mailing Address - Fax:
Practice Address - Street 1:10874 E 2000TH AVE
Practice Address - Street 2:
Practice Address - City:SHUMWAY
Practice Address - State:IL
Practice Address - Zip Code:62461-2267
Practice Address - Country:US
Practice Address - Phone:217-821-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107334207P00000X
OH57-000425207P00000X
HIMDR-4086207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107334Medicaid
H77165Medicare UPIN
IL036107334Medicaid