Provider Demographics
NPI:1760608780
Name:BROWN, JOHN ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 915 W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2211
Mailing Address - Country:US
Mailing Address - Phone:312-266-7404
Mailing Address - Fax:
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:SUITE 915 W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2211
Practice Address - Country:US
Practice Address - Phone:312-266-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T36911Medicare UPIN
IL520940Medicare ID - Type Unspecified