1003865304 NPI number — DR. MICHAEL J BROWN MD

Table of content: DR. MICHAEL J BROWN MD (NPI 1003865304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003865304 NPI number — DR. MICHAEL J BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MICHAEL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003865304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3999 DUTCHMANS LN, SUITE #3A
Provider Second Line Business Mailing Address:
SUBURBAN PLAZA ONE
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40207-4714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-897-7300
Provider Business Mailing Address Fax Number:
502-897-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3999 DUTCHMANS LN, SUITE #3A
Provider Second Line Business Practice Location Address:
SUBURBAN PLAZA ONE
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-7300
Provider Business Practice Location Address Fax Number:
502-897-3332
Provider Enumeration Date:
05/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  35789 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Y00000X , with the licence number: 01058901A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200483440A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2445466000 . This is a "PASSPORT ADVANTAGE #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000335350 . This is a "INDIANA ANTHEM NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00163950 . This is a "RAILROAD MEDICARE NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64078066 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7063240 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000335350 . This is a "KENTUCKY ANTHEM NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200458400 . This is a "INDIANA GROUP MEDICAID #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 7455590 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50004083 . This is a "KENTUCKY PASSPORT #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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