Basic Information
Provider Information | |||||||||
NPI: | 1538699723 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BROWNELL | ||||||||
FirstName: | JOSHUA | ||||||||
MiddleName: | ROBERT | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1860 PAYSPHERE CIR | ||||||||
Address2: |   | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606740018 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6304699200 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1300 N ARLINGTON HEIGHTS RD STE 130 | ||||||||
Address2: |   | ||||||||
City: | ITASCA | ||||||||
State: | IL | ||||||||
PostalCode: | 601433128 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8478714540 | ||||||||
FaxNumber: | 8478714597 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/19/2017 | ||||||||
LastUpdateDate: | 09/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 036-160946 | IL | Y |   | Allopathic & Osteopathic Physicians | Allergy & Immunology |   | 207RA0201X | 73010-20 | WI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | 207R00000X | 2017020344 | MO | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.