Healthcare Provider Details

I. General information

NPI: 1346242088
Provider Name (Legal Business Name): EUGENE W BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 W MELROSE ST
CHICAGO IL
60657-3417
US

IV. Provider business mailing address

773 W MELROSE ST
CHICAGO IL
60657-3417
US

V. Phone/Fax

Practice location:
  • Phone: 773-474-1090
  • Fax:
Mailing address:
  • Phone: 773-474-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: