Provider Demographics
NPI:1699134973
Name:BERKLEY-VIGIL, BRANDON AMADEO (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:AMADEO
Last Name:BERKLEY-VIGIL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3 CRESTVIEW TER
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2107
Mailing Address - Country:US
Mailing Address - Phone:847-909-2004
Mailing Address - Fax:847-433-8906
Practice Address - Street 1:130 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHWOOD
Practice Address - State:IL
Practice Address - Zip Code:60040-1122
Practice Address - Country:US
Practice Address - Phone:847-909-2004
Practice Address - Fax:847-433-8906
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.005755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant