Individual
ASHANTA BRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1950 W POLK ST STE 5210, CHICAGO, IL 60612-3723
(312) 864-0390
Mailing address
1950 W POLK ST STE 5210, CHICAGO, IL 60612-3723
(312) 864-0390
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036.170779
IL
208000000X
Pediatrics Physician
036.170779
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.170779
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
05/13/2020
Last updated
06/28/2024
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