Individual
DR. BRUCE ALLEN BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6440 GRAND AVE, SUITE 206, GURNEE, IL 60031-5257
(847) 782-8349
(847) 782-8546
Mailing address
3183 PAYSPHERE CIR, CHICAGO, IL 60674-0031
(708) 492-0502
(708) 492-0565
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036090508
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635877
BCBS
IL
05
—
036090508
—
IL
01
—
04921836
BLUE CROSS BLUE SHIELD
—
01
—
1518027812
NPI
IL
01
—
212210
MEDICARE
IL
01
—
214706
MEDICARE
IL
01
—
DE5300
MEDICARE
IL
01
—
R00709
MEDICARE
IL
Enumeration date
07/13/2006
Last updated
01/06/2010
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