Provider Demographics
NPI:1417053901
Name:BROWN, ANTHONY LEE (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEE
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 1:3235 VOLLMER RD
Mailing Address - Street 2:SUITE 147
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2013
Mailing Address - Country:US
Mailing Address - Phone:708-799-2333
Mailing Address - Fax:708-799-8987
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:SUITE 147
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2013
Practice Address - Country:US
Practice Address - Phone:708-799-2333
Practice Address - Fax:708-799-8987
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036040146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036040146Medicaid
IL036040146Medicaid
IL0384720001Medicare NSC
ILD12275Medicare UPIN