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1578129102
BRODY DAVID ILSTRUP
KENOSHA, WI
NPI
1578129102
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2019-05-20
Last Update Date
2019-05-20
Business Address
BRODY DAVID ILSTRUP
2001 ALFORD PARK DR
KENOSHA, WI 53140-1927
Phone number: 612-865-8656
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Mailing Address
BRODY DAVID ILSTRUP
2001 ALFORD PARK DR
KENOSHA, WI 53140-1927
Phone number:
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