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General NPI Number Information
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NPI Number | 1861835985
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Entity Type | Individual
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Provider Name | CHRISTIE ANN BRILLANTE MD
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Gender | Female
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 1801 W. TAYLOR, SUITE 3C
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City | CHICAGO
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State | IL
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Zip | 60612-4795
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Country | US
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Telephone | 312-996-2740
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Fax |
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Provider Business Mailing Address
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Address Line | 840 S WOOD ST RM 920-N
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City | CHICAGO
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State | IL
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Zip | 60612-4325
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Country | US
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Telephone | 312-996-8039
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036.140825
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License Number State | IL
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