MEDICARE: DR. EUGENE W 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
1	2085N0700X	Neuroradiology Physician		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00321056	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1346242088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE W BROWN M.D.

Provider Business Mailing Address
First Line	:	773 W MELROSE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3417
Country	:	US
Telephone Number	:	773-474-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	773 W MELROSE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3417
Country	:	US
Telephone Number	:	773-474-1090
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/29/2007

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