Provider Demographics
NPI:1124008487
Name:BROWN, HENRY (MD PHD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(EMS BLDG., RM. 2209)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-3250
Mailing Address - Fax:708-216-2620
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(EMS BLDG., RM. 2209)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-3250
Practice Address - Fax:708-216-2620
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36110100207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36110100Medicaid
G77749Medicare UPIN
IL207377Medicare ID - Type Unspecified
IL36110100Medicaid