1083957385 NPI number — DR. ELIZABETH LUMSDEN BRILL M.D.

Table of content: DR. ELIZABETH LUMSDEN BRILL M.D. (NPI 1083957385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083957385 NPI number — DR. ELIZABETH LUMSDEN BRILL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRILL
Provider First Name:
ELIZABETH
Provider Middle Name:
LUMSDEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
LUMSDEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083957385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 E HURON ST
Provider Second Line Business Mailing Address:
FEINBERG PAVILION 5-702C
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-926-9503
Provider Business Mailing Address Fax Number:
312-926-0860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 E HURON ST
Provider Second Line Business Practice Location Address:
FEINBERG PAVILION 5-702C
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-926-9503
Provider Business Practice Location Address Fax Number:
312-926-0860
Provider Enumeration Date:
04/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  036129007 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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