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NPI Code Detail

MEDICARE: DAVID BROGAN MD

MEDICARE: DAVID BROGAN MD
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
12085R0202XDiagnostic Radiology Physician036160427IL
2207T00000XNeurological Surgery PhysicianLL40928SC

General Provider Information

NPI Number : 1538689922
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID BROGAN MD
Provider Business Mailing Address
First Line : 2650 RIDGE AVE STE 1223
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1700
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5145 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3661
Country : US
Telephone Number : 773-989-3814
Fax Number : 773-989-6230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2017
Last Update Date : 12/16/2025

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Directions to “ DAVID BROGAN MD” Practice Location

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