Provider Demographics
NPI:1548367535
Name:BROWN, GREGORY M (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH CHICAGO, LLC
Mailing Address - Street 2:2231 E. 95TH STREET
Mailing Address - City:CHICAGO
Mailing Address - State:IL - ILLINOIS
Mailing Address - Zip Code:60617
Mailing Address - Country:UM
Mailing Address - Phone:773-768-7700
Mailing Address - Fax:312-276-9660
Practice Address - Street 1:19310 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1562
Practice Address - Country:US
Practice Address - Phone:708-300-3132
Practice Address - Fax:773-790-4034
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL016004793213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004793Medicaid
IL0001621735OtherBCBS
IL7552001OtherPTAN
ILP00245960OtherRAILROAD MEDICARE
ILP00245960OtherRAILROAD MEDICARE
IL7552001OtherPTAN
IL0993630001Medicare NSC