Provider Demographics
NPI:1750382560
Name:BROWN, HEATHER M (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:BROWN
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 1:2225 ENTERPRISE DR
Mailing Address - Street 2:SUITE 2511
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5814
Mailing Address - Country:US
Mailing Address - Phone:708-486-0076
Mailing Address - Fax:
Practice Address - Street 1:2225 ENTERPRISE DR
Practice Address - Street 2:SUITE 2511
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5814
Practice Address - Country:US
Practice Address - Phone:708-486-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112231207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112231Medicaid
IL220030635Medicare PIN
216096003Medicare PIN
ILH39156Medicare UPIN
IL036112231Medicaid