Healthcare Provider Details

I. General information

NPI: 1497564405
Provider Name (Legal Business Name): SHIRLEY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 POINT BLVD
ELGIN IL
60123-7871
US

IV. Provider business mailing address

2250 POINT BLVD
ELGIN IL
60123-7871
US

V. Phone/Fax

Practice location:
  • Phone: 773-308-4499
  • Fax:
Mailing address:
  • Phone: 773-308-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: