Provider Demographics
NPI:1518104322
Name:D. DUANE BRANN, DPM, PC
Entity Type:Organization
Organization Name:D. DUANE BRANN, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:BRANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-403-0030
Mailing Address - Street 1:16523 S. 106TH COURT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4545
Mailing Address - Country:US
Mailing Address - Phone:708-403-0030
Mailing Address - Fax:708-403-0037
Practice Address - Street 1:16523 S. 106TH COURT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4545
Practice Address - Country:US
Practice Address - Phone:708-403-0030
Practice Address - Fax:708-403-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003703213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38418Medicare UPIN
IL6232950001Medicare NSC