Provider Demographics
NPI:1528125473
Name:MCCARTHY, BRENDON JEREMIAH (DPM)
Entity type:Individual
Prefix:
First Name:BRENDON
Middle Name:JEREMIAH
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HOBSON RD
Mailing Address - Street 2:SUITE 248
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8139
Mailing Address - Country:US
Mailing Address - Phone:630-548-3900
Mailing Address - Fax:630-548-3905
Practice Address - Street 1:1220 HOBSON RD
Practice Address - Street 2:SUITE 248
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8139
Practice Address - Country:US
Practice Address - Phone:630-548-3900
Practice Address - Fax:630-548-3905
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16004854213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU69157Medicare UPIN
IL706990Medicare PIN
IL5916070001Medicare NSC