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NPI Code Detail

MEDICARE: GREG A BROOKS CRNA

MEDICARE: GREG A BROOKS CRNA
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
1367500000XCertified Registered Nurse Anesthetist28162626AIN
2367500000XCertified Registered Nurse AnesthetistAP114460TX
3367500000XCertified Registered Nurse Anesthetist209009504IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255322459
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREG A BROOKS CRNA
Provider Business Mailing Address
First Line : 520 N KINGSBURY ST UNIT 3201
Second Line :
City : CHICAGO
State : IL
Zip : 60654-8777
Country : US
Telephone Number : 574-229-5636
Fax Number :
Provider Business Practice Location Address
First Line : 2875 W 19TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-3501
Country : US
Telephone Number : 773-484-4099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 03/17/2018

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