Provider Demographics
NPI:1275856718
Name:BROWN, BRIAN M
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:M
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BALANCE
Other - Middle Name:
Other - Last Name:MEDICAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3220 185TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2701
Mailing Address - Country:US
Mailing Address - Phone:312-671-0081
Mailing Address - Fax:
Practice Address - Street 1:3220 185TH PL
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2701
Practice Address - Country:US
Practice Address - Phone:312-671-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
ILNOT REQUIRED246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic