Provider Demographics
NPI:1942272968
Name:BROWN, CHARLES K (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
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 1:5201 WILLOW SPRINGS RD STE 290
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6506
Mailing Address - Country:US
Mailing Address - Phone:708-579-0018
Mailing Address - Fax:
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 290
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6506
Practice Address - Country:US
Practice Address - Phone:708-579-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1021562086X0206X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100820369Medicaid
PAH27073Medicare UPIN
PA073431FKYMedicare ID - Type Unspecified