Individual
MALCOLM BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
176 N LECLAIRE AVE, CHICAGO, IL 60644-3413
(773) 688-5299
Mailing address
176 N LECLAIRE AVE, CHICAGO, IL 60644-3413
(773) 688-5299
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
A-2256-0001-A
IL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
A-2256-0001-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008144
—
IL
05
—
1629553748
—
IL
05
—
A-2256-0001-A
—
IL
Enumeration date
09/25/2018
Last updated
10/22/2018
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