| Brian Olofsson Md, Llc | |
|
400 N Wall St Ste 510 Kankakee IL 60901-2965 | |
| (815) 932-5725 | |
| (815) 932-5872 |
| Full Name | Brian Olofsson Md, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 400 N Wall St Ste 510, Kankakee, Illinois |
| Authorized Official Name and Position | Brian Olofsson (PHYSICIAN/OWNER) |
| Authorized Official Contact | 8159325725 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Olofsson Md, Llc 400 N Wall St Ste 510 Kankakee IL 60901-2965 Ph: (815) 932-5725 | Brian Olofsson Md, Llc 400 N Wall St Ste 510 Kankakee IL 60901-2965 Ph: (815) 932-5725 |
| NPI Number | 1871067496 |
|---|---|
| Provider Enumeration Date | 01/16/2019 |
| Last Update Date | 01/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871067496 | NPI | - | NPPES |
| 036067325 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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