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General NPI Number Information
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NPI Number | 1154856870
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Entity Type | Organization
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Legal Business Name | HOWARD BROWN HEALTH CENTER
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 641 W 63RD ST BSMT
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City | CHICAGO
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State | IL
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Zip | 60621-2032
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Country | US
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Telephone | 773-388-1600
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Fax | 773-388-8936
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Provider Business Mailing Address
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Address Line | 4025 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60613-2010
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Country | US
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Telephone | 773-388-1600
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | BURGUNDY JOHNSON
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Credential |
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Telephone | 872-629-3491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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