Provider Demographics
NPI:1033237789
Name:REILLY, BRENDAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:MICHAEL
Last Name:REILLY
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:JOHN H. STROGER JR HOSPITAL OF COOK COUNTY
Mailing Address - Street 2:1901 WEST HARRISON ST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-864-7201
Mailing Address - Fax:312-864-9725
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:ROOM 1500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-7201
Practice Address - Fax:312-864-9725
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072219207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine