Provider Demographics
NPI:1477712040
Name:BRANCATO, SAM JOSEPH (MD, MS)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:JOSEPH
Last Name:BRANCATO
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1270 EAGLE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 W COURT ST STE 403
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3695
Practice Address - Country:US
Practice Address - Phone:815-939-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD75794208800000X
NY284371208800000X
DCMD042437208800000X
IL036130870208800000X
CAC157659208800000X
IAMD-43528208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology