MEDICARE: DR. JOSEEN A BRYANT 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	207Q00000X	Family Medicine Physician	A136892	CA
2	207Q00000X	Family Medicine Physician	125059834	IL
3	207QS0010X	Sports Medicine (Family Medicine) Physician	125059834	IL
4	207QS0010X	Sports Medicine (Family Medicine) Physician	01078174A	IN
5	207QS0010X	Sports Medicine (Family Medicine) Physician	036134797	IL

General Provider Information

NPI Number	:	1326333618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEEN A BRYANT M.D.

Provider Business Mailing Address
First Line	:	8049 W 85TH CT
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-8981
Country	:	US
Telephone Number	:	615-260-8682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 150
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3524
Country	:	US
Telephone Number	:	847-982-3172
Fax Number	:

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

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	02/06/2023

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