Provider Demographics
NPI:1326333618
Name:BRYANT, JOSEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEEN
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8049 W 85TH CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8981
Mailing Address - Country:US
Mailing Address - Phone:615-260-8682
Mailing Address - Fax:
Practice Address - Street 1:2740 W FOSTER AVE STE 150
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3524
Practice Address - Country:US
Practice Address - Phone:847-982-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136892207Q00000X
IL125059834207Q00000X, 207QS0010X
IN01078174A207QS0010X
IL036134797207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine