Active NPI
Brian Michael Braithwaite, M.D.
- Plastic and Reconstructive Surgery Physician
- Chicago, IL
National Provider Identifier
1518020072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic and Reconstructive Surgery Physician
- License
- 036096170
- Practice address
- 601 W Randolph St
Chicago, IL 60661-2232 - Phone
- (312) 258-9100
- Fax
- (312) 258-1219
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic and Reconstructive Surgery Physician | 2086S0122X | 036096170 | IL | Primary |
Addresses
Primary practice location
601 W Randolph St
Chicago, IL 60661-2232
Mailing address
601 W Randolph St
Chicago, IL 60661-2232
Phone (312) 258-9100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2702050216061101 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036096170 | IL | MD | Plastic and Reconstructive Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268956800000",
"number": "1518020072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 W RANDOLPH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606612232",
"telephone_number": "312-258-9100",
"fax_number": "312-258-1219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 W RANDOLPH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606612232",
"telephone_number": "312-258-9100",
"fax_number": "312-258-1219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAITHWAITE",
"first_name": "BRIAN",
"middle_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2010-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "IL",
"license": "036096170",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2702050216061101",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.