Organization
ASMSC-MORTON GROVE IL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARENCE W BROWN JR. M.D., J.D. (OWNER/CEO/PRESIDENT)
(269) 985-0021
Entity
Organization
Contact information
Practice address
9300 WAUKEGAN RD, MORTON GROVE, IL 60053-1312
(847) 299-1044
(847) 299-0425
Mailing address
2570 NILES RD, SAINT JOSEPH, MI 49085-3203
(269) 985-0021
(269) 281-0281
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207ZD0900X
Dermatopathology (Pathology) Physician
—
—
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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