Provider Demographics
NPI:1528133907
Name:ING, BRIAN L (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:ING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:(1950 S. HARLEM AVE., NO RIVERSIDE, IL. 60548)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-354-9250
Mailing Address - Fax:708-354-8765
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(1950 S. HARLEM AVE., NO RIVERSIDE, IL. 60548)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-354-9250
Practice Address - Fax:708-354-8765
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036102297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL585570Medicare ID - Type Unspecified
H18601Medicare UPIN