MEDICARE: ROSEANN E BRADY DO SC

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	207R00000X	Internal Medicine Physician	036101474	IL

General Provider Information

NPI Number	:	1124297056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEANN E BRADY DO SC

Provider Business Mailing Address
First Line	:	110 S WYNSTONE PARK DR
Second Line	:	SUITE 101
City	:	NORTH BARRINGTON
State	:	IL
Zip	:	60010-6979
Country	:	US
Telephone Number	:	224-848-4256
Fax Number	:	847-277-9997

Provider Business Practice Location Address
First Line	:	110 S WYNSTONE PARK DR
Second Line	:	SUITE 101
City	:	NORTH BARRINGTON
State	:	IL
Zip	:	60010-6979
Country	:	US
Telephone Number	:	224-848-4256
Fax Number	:	847-277-9997

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROSEANN E BRADY
Credential	:	D.O.
Telephone Number	:	22248484256

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	03/01/2011

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