Provider Demographics
NPI:1528024254
Name:WURTH, BRETT A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:WURTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62781-0001
Mailing Address - Country:US
Mailing Address - Phone:217-788-5495
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL MEDICAL CTR
Practice Address - Street 2:701 N 1ST STREET
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-0001
Practice Address - Country:US
Practice Address - Phone:217-788-5495
Practice Address - Fax:217-788-5496
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114802207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114802OtherBC OF IL
IL036114802Medicaid
ILK30631Medicare ID - Type Unspecified
IL036114802OtherBC OF IL