Healthcare Provider Details

I. General information

NPI: 1083827810
Provider Name (Legal Business Name): DESLYN S BROWNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE STE 203
CHICAGO IL
60622-1775
US

IV. Provider business mailing address

1000 REMINGTON BLVD STE 100
BOLINGBROOK IL
60440-4707
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-1222
  • Fax: 773-278-4598
Mailing address:
  • Phone:
  • Fax: 630-914-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number036118263
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number036118263
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036118263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: