Look up the most recent NPI and PECOS records

Brigham Douglas

Surgery

Allopathic & Osteopathic Physicians

1900 W Polk St, Chicago, IL 60612-3723

PECOS Enrollment

Based on the most recent information from CMS, provider Brigham Douglas is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1265748883
Provider Type
Individual
Full Name
Douglas, Brigham
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
8/19/2010
Last Updated
9/16/2022

Contact Information

Practice Location

1900 W Polk St, Chicago, IL 60612-3723

(312) 864-1000

Unlisted Fax

Mailing Location

3146 Huula Dr, Oceanside, CA 92058-0619

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208600000X Primary	Description Surgery Allopathic & Osteopathic Physicians	License 0101250169 Virginia
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Brigham Douglas

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Marcus, Elizabeth Ann

Blackwood, Brian P

Knight, Jimmie

Chalman, Mckenna Jay

Hornsby, Cheryl Elise

Makiewicz, Kristine Urban

Forouzan, Eli

Sincavage, John

Williams, Cassidy

Dowling, Colin