| Organization Name: | MED PLUS PHYSICAL MEDICINE LLC |
| NPI Number: | 1053606020 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW W BRETZ (OWNER) |
| Mailing Address: | 18209 Eula Mae Pkwy Carlyle |
| State: | IL US |
| Postal Code: | 622316407 |
| Phone Number: | 6185943671 |
| Fax Number: | 6185948058 |
| NPI Enumeration Date: | 06/17/2011 |
| NPI Last Update Date: | 06/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |