Provider Demographics
NPI:1811085293
Name:BROWN, TERRY MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-1433
Mailing Address - Country:US
Mailing Address - Phone:618-993-0086
Mailing Address - Fax:215-895-3005
Practice Address - Street 1:8305 EXPRESS DR STE C
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-7771
Practice Address - Country:US
Practice Address - Phone:618-993-0086
Practice Address - Fax:618-993-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS146992084S0012X
ALDO-2642084S0012X
GA0287352084S0012X
NC294622084S0012X
IL0361096632084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00118900OtherRAILROAD MEDICARE- PIN
IA0723320Medicaid
IL3932015OtherBLUECROSS BLUESHIELD OF ILLINOIS
IL208084OtherMEDICARE- GROUP NUMBER
ILDF5180OtherRAILROAD MEDICARE- GROUP NUMBER
IL036109663Medicaid
IL088817OtherHEALTH ALLIANCE
IL660328OtherHEALTHLINK
ILDF5180OtherRAILROAD MEDICARE- GROUP NUMBER
IL660328OtherHEALTHLINK