Provider Demographics
NPI:1689822884
Name:BROPHY, ALISON MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:MARIE
Last Name:BROPHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:ALISON
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:17705 HUTCHINS DRIVE, SUITE 101
Mailing Address - Street 2:SOUTH LAKE PEDIATRICS
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-401-8300
Mailing Address - Fax:952-401-8373
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:SUITE 215
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-323-0890
Practice Address - Fax:630-323-9652
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics