MEDICARE: NYESHA LENAI BROWN DO

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	207Q00000X	Family Medicine Physician	036.175651	IL

General Provider Information

NPI Number	:	1093456923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYESHA LENAI BROWN DO

Provider Business Mailing Address
First Line	:	180 HARVESTER DR STE 110
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-6686
Country	:	US
Telephone Number	:	609-394-6031
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE # 6098
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1443
Country	:	US
Telephone Number	:	855-702-8222
Fax Number	:

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/20/2026

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