Provider Demographics
NPI:1811013857
Name:HUGH, BRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:HUGH
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 1:2850 W 95TH ST STE 11
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2727
Mailing Address - Country:US
Mailing Address - Phone:708-425-0200
Mailing Address - Fax:708-425-0208
Practice Address - Street 1:2850 W 95TH ST STE 11
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2727
Practice Address - Country:US
Practice Address - Phone:708-425-0200
Practice Address - Fax:708-425-0208
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine