Provider Demographics
NPI:1023190063
Name:BROFMAN, JOHN D (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:BROFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3471
Mailing Address - Country:US
Mailing Address - Phone:815-463-8994
Mailing Address - Fax:815-463-8946
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:815-463-8994
Practice Address - Fax:815-463-8946
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072874207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072874Medicaid
ILP00061472OtherRAILROAD MEDICARE PIN
IL36072874OtherSTATE OF ILLINOIS LICENSE
ILP00061472OtherRAILROAD MEDICARE PIN
ILE19049Medicare UPIN
IL036072874Medicaid