MEDICARE: DR. KENNETH P. BRIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036-120806	IL

General Provider Information

NPI Number	:	1013982099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH P. BRIN M.D.

Provider Business Mailing Address
First Line	:	180 E PEARSON ST APT 6201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2191
Country	:	US
Telephone Number	:	630-310-2170
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 E PEARSON ST APT 6201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2191
Country	:	US
Telephone Number	:	630-719-4799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/28/2024

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