Provider Demographics
NPI:1346242088
Name:BROWN, EUGENE W (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:W
Last Name:BROWN
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 1:773 W MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3417
Mailing Address - Country:US
Mailing Address - Phone:773-474-1090
Mailing Address - Fax:
Practice Address - Street 1:773 W MELROSE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3417
Practice Address - Country:US
Practice Address - Phone:773-474-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00321056OtherRAILROAD MEDICARE
ILK26581Medicare PIN
ILE40929Medicare UPIN