Healthcare Provider Details

I. General information

NPI: 1811019110
Provider Name (Legal Business Name): BRIAN URBAN AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH ST SUITE 307
EVANSTON IL
60201-4508
US

IV. Provider business mailing address

636 CHURCH ST SUITE 307
EVANSTON IL
60201-4508
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-9433
  • Fax:
Mailing address:
  • Phone: 847-869-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-001164
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: