Provider Demographics
NPI:1265514202
Name:PULMONARY AND CRITICAL CARE PHYSICIANS PC
Entity type:Organization
Organization Name:PULMONARY AND CRITICAL CARE PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-783-2644
Mailing Address - Street 1:3231 EUCLID AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3471
Mailing Address - Country:US
Mailing Address - Phone:708-783-2644
Mailing Address - Fax:815-463-8946
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:708-783-2644
Practice Address - Fax:815-463-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202143Medicare PIN