Healthcare Provider Details

I. General information

NPI: 1447312889
Provider Name (Legal Business Name): BRIAN SCOTT MORSE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 N PULASKI RD STE E
CHICAGO IL
60630-1761
US

IV. Provider business mailing address

5240 N PULASKI RD STE E
CHICAGO IL
60630-1761
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-1857
  • Fax:
Mailing address:
  • Phone: 773-883-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-103999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: