MEDICARE: DR. GEORGE BRODSKY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036104522	IL
2	208M00000X	Hospitalist Physician	036104522	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417928714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE BRODSKY M.D.

Provider Business Mailing Address
First Line	:	9201 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2102
Country	:	US
Telephone Number	:	847-626-1600
Fax Number	:	847-626-1650

Provider Business Practice Location Address
First Line	:	9201 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2102
Country	:	US
Telephone Number	:	847-626-1600
Fax Number	:	847-626-1650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	10/18/2022

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