Provider Demographics
NPI:1184601015
Name:SILVERSTEIN, BRIAN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAY
Last Name:SILVERSTEIN
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 1:1000 ELM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1129
Mailing Address - Country:US
Mailing Address - Phone:443-602-4016
Mailing Address - Fax:
Practice Address - Street 1:W3329 BURR OAK DR
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4323
Practice Address - Country:US
Practice Address - Phone:847-271-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine