Healthcare Provider Details

I. General information

NPI: 1326333618
Provider Name (Legal Business Name): JOSEEN A BRYANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE STE 150
CHICAGO IL
60625-3524
US

IV. Provider business mailing address

8049 W 85TH CT
CROWN POINT IN
46307-8981
US

V. Phone/Fax

Practice location:
  • Phone: 847-982-3172
  • Fax:
Mailing address:
  • Phone: 615-260-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA136892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125059834
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number125059834
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01078174A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036134797
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: