Brown, Malcolm
Brown, Malcolm is an individual health care provider with primary practice located at 176 N Leclaire Ave , Chicago IL 60644-3413. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Addiction Medicine is his primary health care specialty. Brown, Malcolm can be contacted via phone (773) 688-5299.Contact Information
Primary practice address
176 N Leclaire Ave
Chicago IL 60644-3413
Phone: (773) 688-5299
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 103TA0400X | A-2256-0001-A | Illinois |
Allopathic & Osteopathic Physicians / Addiction Medicine | 2084A0401X | A-2256-0001-A | Illinois |
Profile Details
NPI number | 1629553748 |
---|---|
LBN Legal business name | Brown, Malcolm |
Credentials | |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Sep 25th, 2018 |
Last updated | Oct 22nd, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1629553748 | NPPES |
Illinois | MEDICAID | 1629553748 | |
Illinois | MEDICAID | 008144 | |
Illinois | MEDICAID | A-2256-0001-A |
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