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General NPI Number Information
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NPI Number | 1215431994
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Entity Type | Individual
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Provider Name | BRITTANY SHANNON MEAD MD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 1750 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3825
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Country | US
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Telephone | 312-942-6510
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E BROOKLYN VILLAGE AVE UNIT 1001
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City | CHARLOTTE
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State | NC
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Zip | 28202-3625
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036171876
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License Number State | IL
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