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NPI Code Detail

MEDICARE: DR. NANCY BUNN BROWN M.D.

MEDICARE: DR. NANCY BUNN BROWN 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
1208000000XPediatrics Physician036.129956IL

General Provider Information

NPI Number : 1104052513
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANCY BUNN BROWN M.D.
Provider Business Mailing Address
First Line : 36100 N BROOKSIDE DR STE 106
Second Line :
City : GURNEE
State : IL
Zip : 60031-4572
Country : US
Telephone Number : 847-821-9500
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-4403
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2009
Last Update Date : 01/14/2026

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