Healthcare Provider Details

I. General information

NPI: 1932835998
Provider Name (Legal Business Name): BILLIE EDEN BRENNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BILLIE EDEN ZIDEL MD

II. Dates (important events)

Enumeration Date: 07/30/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 165TH ST
HAMMOND IN
46320-2823
US

IV. Provider business mailing address

1110 W LAKE ST
CHICAGO IL
60607-1680
US

V. Phone/Fax

Practice location:
  • Phone: 219-600-5208
  • Fax:
Mailing address:
  • Phone: 347-209-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4351049787
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: