THOMAS KEVIN BRATTAIN (NPI# 1285613463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1285613463 |
Entity Type | Individual |
Full Name | THOMAS KEVIN BRATTAIN |
Credential | DPM |
Practice Address |
3322 W Willow Knolls Dr Peoria IL 61614-8148 |
Practice Telephone | 3096915800 |
Practice Fax Number | 3096911336 |
Mailing Telephone | 3096915800 |
Mailing Fax Number | 3096911336 |
Enumeration Date | 2006-01-16 |
Last Update Date | 2008-04-03 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016003267 | IL | Podiatric Medicine & Surgery Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | MEDICARE RAILROAD | 480009789 | 01 |
IL | 016003267 | 05 | |
IL | BLUE CROSS BLUE SHIELD | 0007215174 | 01 |
IL | MEDICARE PROVIDER NUMBER | 928270 | 01 |
Street Address |
3322 W WILLOW KNOLLS DR |
City | PEORIA |
State | IL |
Zip Code | 61614-8148 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336549427 | Patricia Geffre-starr | Massage Therapist | 3322 W Willow Knolls Dr, Peoria, IL 61614-8148 | 2014-08-26 |
1447659008 | Michelle L Carlson | Massage Therapist | 3322 W Willow Knolls Dr, Suite B, Peoria, IL 61614-8148 | 2014-08-20 |
1518387109 | Justin R. Ahlman, M.d. | Anesthesiology | 3322 W Willow Knolls Dr, Peoria, IL 61614-8148 | 2014-04-22 |
1093885378 | Mark Alan Smith | Podiatrist | 3322 W Willow Knolls Dr, Peoria, IL 61614 | 2006-11-08 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
Find all providers in zip 61614 |
Taxonomy Code | 213E00000X |
Grouping | Podiatric Medicine & Surgery Service Providers |
Classification | Podiatrist |
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699065839 | Keith Bangart Dpm PC | Podiatrist | 13660 N 94th Dr Ste F1, Peoria, AZ 85381-4232 | 2011-04-08 |
1962689489 | Dan Bangart Plc | Podiatrist | 13660 N 94th Drive, Suite F-1, Peoria, AZ 85381-4323 | 2008-01-28 |
1770540700 | Teisha M Kubala | Podiatrist | 8325 W Happy Valley Rd, Unit 105, Peoria, AZ 85383-4361 | 2006-04-26 |
1336135177 | David M Bates | Podiatrist | 15182 N 75th Ave, Ste 160, Peoria, AZ 85381-4722 | 2005-09-27 |
1689939985 | Annie Jong | Podiatrist | 13660 N 94th Dr, Ste A3, Peoria, AZ 85381-4836 | 2012-07-12 |
1306101571 | Steven Shane Moore | Podiatrist | 13660 N 94th Dr Ste F1, Peoria, AZ 85381-4232 | 2012-07-12 |
1013216373 | Keith Thomas Bangart | Podiatrist | 13660 N 94th Dr, #f1, Peoria, AZ 85381-4836 | 2011-03-24 |
1689978397 | Edward Au | Podiatrist | 9171 W Thunderbird Rd, Ste 101, Peoria, AZ 85381-4872 | 2011-01-10 |
1629208723 | John Charles Hart | Podiatrist | 300 E War Memorial Dr, Suite 200, Peoria, IL 61614-7570 | 2009-07-23 |
1982817912 | Achilles Heel LLC | Podiatrist | 13660 N 94th Dr, Ste A-3, Peoria, AZ 85381-4836 | 2007-05-07 |
Find all providers in PEORIA |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.