Individual
BRITTANY BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
180 HARVESTER DR, SUITE 110, BURR RIDGE, IL 60527-7594
(773) 834-4284
Mailing address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1447
(773) 834-4284
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
085004776
IL
363A00000X
Physician Assistant
Primary
085004776
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329043901
—
TX
01
—
8096NF
BCBS
TX
Enumeration date
10/30/2013
Last updated
04/30/2015
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