Provider Demographics
NPI:1457320467
Name:KRETSCHMER, BRIAN (ATC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KRETSCHMER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 W 90TH PL
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1540
Mailing Address - Country:US
Mailing Address - Phone:708-351-6107
Mailing Address - Fax:
Practice Address - Street 1:9400 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2372
Practice Address - Country:US
Practice Address - Phone:708-741-5801
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program