Provider Demographics
NPI:1962723981
Name:BROOKS, KATRICE MARIE (MD)
Entity type:Individual
Prefix:
First Name:KATRICE
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19310 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1562
Mailing Address - Country:US
Mailing Address - Phone:708-300-3132
Mailing Address - Fax:773-790-4034
Practice Address - Street 1:19310 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1562
Practice Address - Country:US
Practice Address - Phone:708-300-3132
Practice Address - Fax:773-790-4034
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61357-20207Q00000X
IL036158316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine