Provider Demographics
NPI:1235182809
Name:ATWOOD, BRIAN LEE (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:ATWOOD
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 1:1400 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2426
Mailing Address - Country:US
Mailing Address - Phone:618-395-1400
Mailing Address - Fax:618-395-1405
Practice Address - Street 1:1400 N EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2426
Practice Address - Country:US
Practice Address - Phone:618-395-1400
Practice Address - Fax:618-395-1405
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL095145OtherHEALTHALLIANCE
IL662903OtherHEALTHLINK
ILH77584Medicare UPIN
IL208897Medicare ID - Type Unspecified