Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036.144255 | IL |
NPI | 1134338981 |
---|---|
Provider Name | Ouida Brown |
First Address | Chicago, IL 60616-2315 |
Second Address | Chicago, IL 60616-2315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 02/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F400129053 | MEDICARE PTAN (01) | IL |