Provider Demographics
NPI:1730272964
Name:CURTIS, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CURTIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 MAXINE DRIVE, SUITES 3 & 4
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550
Mailing Address - Country:US
Mailing Address - Phone:306-263-2424
Mailing Address - Fax:309-284-2255
Practice Address - Street 1:435 MAXINE DRIVE, SUITES 3 & 4
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550
Practice Address - Country:US
Practice Address - Phone:306-263-2424
Practice Address - Fax:309-284-2255
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098433207R00000X
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098433Medicaid
H07685Medicare UPIN
IL809840Medicare ID - Type UnspecifiedGROUP #
ILCA4079Medicare ID - Type UnspecifiedRR GROUP #
ILK21290Medicare ID - Type UnspecifiedINDIVIDUAL #