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Individual

HEIDI SHARON BROOKENTHAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
2535 S KING DR, CHICAGO, IL 60616-4746
(708) 747-7960
(708) 503-3993
Mailing address
2535 S KING DR, CHICAGO, IL 60616-4746
(312) 842-7117
(708) 503-3993

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036103288
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036103288
IL
05
200391070
IN
05
867913
AZ
Enumeration date
10/26/2006
Last updated
12/20/2021
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