Provider Demographics
NPI:1659302347
Name:BRANDON, ELIZABETH M (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:BRANDON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1870 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4356
Mailing Address - Country:US
Mailing Address - Phone:630-859-6700
Mailing Address - Fax:630-859-6941
Practice Address - Street 1:4100 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4163
Practice Address - Country:US
Practice Address - Phone:630-851-3105
Practice Address - Fax:630-978-6669
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36094475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36094475OtherLICENSE
ILL59452Medicare ID - Type Unspecified
ILL59451Medicare ID - Type Unspecified
IL36094475OtherLICENSE