Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036.125434 | IL |
N | 207QS0010X | Family Doctor - Sports Medicine | 036.125434 | IL |
NPI | 1093971806 |
---|---|
Provider Name | Brian Donohue |
First Address | Chicago, IL 60631-3745 |
Second Address | Chicago, IL 60631-3745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 15/03/2021 |