| Mary L Brandenburg, PA | |
|
1301 E Walnut St, Carbondale, IL 62901-5004 | |
| (618) 457-3371 | |
| (618) 457-8931 |
| Full Name | Mary L Brandenburg |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 1301 E Walnut St, Carbondale, Illinois |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649385873 | NPI | - | NPPES |
| 370966854015 | Medicaid | IL | |
| CF3444 | Other | IL | MEDICARE RR |
| 105008 | Other | IL | HEALTH ALLIANCE |
| 085001021 | Other | IL | STATE LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 085-001021 (Illinois) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Mary L Brandenburg, PA Po Box 577, Carterville, IL 62918-0577 Ph: (618) 985-8221 | Mary L Brandenburg, PA 1301 E Walnut St, Carbondale, IL 62901-5004 Ph: (618) 457-3371 |
Mr. Lukas Ward, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 405 W Jackson St, Carbondale, IL 62901 Phone: 618-549-0721 Fax: 618-529-0479 | |
Ms. Britney Nicole Arnold, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 405 W Jackson St, Carbondale, IL 62901 Phone: 618-549-0721 Fax: 618-457-0469 | |
Joeli Diemer, PAC Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 300 W Oak St, Carbondale, IL 62901 Phone: 618-536-6621 | |
Ms. Nicole A Johnson, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 405 W Jackson St, Carbondale, IL 62901 Phone: 618-549-0721 | |
Mr. Michael Leroy Matteson, PA C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 305 W Jackson St, Suite 105, Carbondale, IL 62901 Phone: 618-536-2565 Fax: 618-536-2835 | |
John Howard Davidson, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 405 W Jackson St, Carbondale, IL 62901 Phone: 618-549-0721 Fax: 618-457-0469 | |
Kilmeny Clark, Physician Assistant Medicare: Medicare Enrolled Practice Location: 300 W Oak St, Carbondale, IL 62901 Phone: 618-453-8850 |