Individual
BRIAN MICHAEL BRAITHWAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 W RANDOLPH ST, CHICAGO, IL 60661-2232
(312) 258-9100
(312) 258-1219
Mailing address
601 W RANDOLPH ST, CHICAGO, IL 60661-2232
(312) 258-9100
(312) 258-1219
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
036096170
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2702050216061101
—
IL
Enumeration date
12/18/2006
Last updated
03/19/2010
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