Healthcare Provider Details

I. General information

NPI: 1780621359
Provider Name (Legal Business Name): DONALD BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST SUITE 304
CHICAGO IL
60611-2926
US

IV. Provider business mailing address

233 E ERIE ST SUITE 304
CHICAGO IL
60611-2926
US

V. Phone/Fax

Practice location:
  • Phone: 312-280-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: