1548367535 NPI number — DR. GREGORY M BROWN DPM

Table of content: DR. GREGORY M BROWN DPM (NPI 1548367535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548367535 NPI number — DR. GREGORY M BROWN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
GREGORY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548367535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH CHICAGO, LLC
Provider Second Line Business Mailing Address:
2231 E. 95TH STREET
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL - ILLINOIS
Provider Business Mailing Address Postal Code:
60617
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
773-768-7700
Provider Business Mailing Address Fax Number:
312-276-9660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19310 S HALSTED ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60425-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-300-3132
Provider Business Practice Location Address Fax Number:
773-790-4034
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  016004793 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016004793 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001621735 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7552001 . This is a "PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00245960 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com