Basic Information
| Provider Information | |||||||||
| NPI: | 1841250958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROMET | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1975 LIN LOR LANE | ||||||||
| Address2: | SUITE 175 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477170600 | ||||||||
| FaxNumber: | 8477170297 | ||||||||
| Practice Location | |||||||||
| Address1: | 1975 LIN LOR LN STE 155 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477170600 | ||||||||
| FaxNumber: | 8477170297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 036102329 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 036102329 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 036102329 | 05 | IL | MEDICAID |