Healthcare Provider Details

I. General information

NPI: 1548367535
Provider Name (Legal Business Name): GREGORY M BROWN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19310 S HALSTED ST
GLENWOOD IL
60425-1562
US

IV. Provider business mailing address

JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH CHICAGO, LLC 2231 E. 95TH STREET
CHICAGO IL - ILLINOIS
60617
UM

V. Phone/Fax

Practice location:
  • Phone: 708-300-3132
  • Fax: 773-790-4034
Mailing address:
  • Phone: 773-768-7700
  • Fax: 312-276-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: