Provider Demographics
NPI:1235356304
Name:LYNN GAYE BROWN, M.D., S.C.
Entity Type:Organization
Organization Name:LYNN GAYE BROWN, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-932-2000
Mailing Address - Street 1:500 N WALL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2942
Mailing Address - Country:US
Mailing Address - Phone:815-932-2000
Mailing Address - Fax:815-932-7435
Practice Address - Street 1:500 N WALL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2942
Practice Address - Country:US
Practice Address - Phone:815-932-2000
Practice Address - Fax:815-932-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082934174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDC3815OtherRAILROAD MEDICARE
ILDC3815OtherRAILROAD MEDICARE