Basic Information
| Provider Information | |||||||||
| NPI: | 1093971806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONOHUE | ||||||||
| FirstName: | BRIAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7447 W TALCOTT AVE | ||||||||
| Address2: | SUITE 182 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606313745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737925155 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7447 W TALCOTT AVE | ||||||||
| Address2: | SUITE 182 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606313745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737925155 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2008 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 036.125434 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | 036.125434 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.