Provider Demographics
NPI:1154324515
Name:BROWN, MATTHEW ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:BROWN
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 1:7435 W TALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3707
Mailing Address - Country:US
Mailing Address - Phone:773-792-5145
Mailing Address - Fax:
Practice Address - Street 1:7447 W TALCOTT AVE STE 182
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3712
Practice Address - Country:US
Practice Address - Phone:773-792-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB8587997OtherDEA
IL336-055501OtherCONTROLLED SUBSTANCE
IL36-094405OtherSTATE PHYSICIANS LICENSE
IL36-094405OtherSTATE PHYSICIANS LICENSE