Provider Demographics
NPI:1326080177
Name:BROOKS, HARLEY C III (MD)
Entity Type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:C
Last Name:BROOKS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARLEY
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:900 JORIE BLVD
Mailing Address - Street 2:SUITE 186
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2213
Mailing Address - Country:US
Mailing Address - Phone:630-954-6700
Mailing Address - Fax:630-954-1555
Practice Address - Street 1:900 JORIE BLVD
Practice Address - Street 2:SUITE 186
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2213
Practice Address - Country:US
Practice Address - Phone:630-954-6700
Practice Address - Fax:630-954-1555
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100625207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100625Medicaid
ILL76029OtherMEDICARE PIN - 645650
ILL76024Medicare PIN
ILL76029OtherMEDICARE PIN - 645650