Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 36102536 | IL |
NPI | 1366425175 |
---|---|
Provider Name | Timothy J. Brown |
First Address | Orland Park, IL 60467-8713 |
Second Address | Orland Park, IL 60467-8713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2005 |
Last Update Date | 17/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036102536 | (05) | IL |
H73428 | (02) | IL |