Healthcare Provider Details

I. General information

NPI: 1902007339
Provider Name (Legal Business Name): HARRY BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR DEPARTMENT OF RADIOLOGY
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

903 COMMERCE DR 333
OAK BROOK IL
60523-1969
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3240
  • Fax:
Mailing address:
  • Phone: 773-354-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.115439
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: