Provider Demographics
NPI:1801046958
Name:MARSHALL F. BRUSTEIN M.D.
Entity type:Organization
Organization Name:MARSHALL F. BRUSTEIN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRUSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-872-8204
Mailing Address - Street 1:304 W HAY ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-872-8204
Mailing Address - Fax:
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 112
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-872-8204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006099225X00000X
IL056005019225X00000X
IL036104593332B00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104593Medicaid
IL202268Medicare PIN
ILH17105Medicare UPIN
IL4604910001Medicare NSC
IL206887Medicare PIN
IL206888Medicare PIN