Provider Demographics
NPI:1356408421
Name:BRAZLEY, MARSHA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:JANE
Last Name:BRAZLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4051
Mailing Address - Country:US
Mailing Address - Phone:312-225-2055
Mailing Address - Fax:312-435-1450
Practice Address - Street 1:8747 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6608
Practice Address - Country:US
Practice Address - Phone:312-225-2055
Practice Address - Fax:312-435-1450
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics