Provider Demographics
NPI:1801844311
Name:BROOKS, MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PARK AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1492
Mailing Address - Country:US
Mailing Address - Phone:630-455-7000
Mailing Address - Fax:630-455-7001
Practice Address - Street 1:99 PARK AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1494
Practice Address - Country:US
Practice Address - Phone:630-455-7000
Practice Address - Fax:630-455-7001
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36107404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107404Medicaid
IL036107404Medicaid