Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 036-078967 | IL |
NPI | 1003805375 |
---|---|
Provider Name | Susan G Brown |
First Address | Chicago, IL 60673-0001 |
Second Address | Niles, IL 60714-5905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 10/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-078967 | (05) | IL |
F27054 | (02) | IL |