1316344401 NPI number — MICHAEL BROWN PT, DPT

Table of content: MICHAEL BROWN PT, DPT (NPI 1316344401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316344401 NPI number — MICHAEL BROWN PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
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:
1316344401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33900 HARPER AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48035-4258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-350-2644
Provider Business Mailing Address Fax Number:
586-541-3735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 75TH ST STE 145B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODRIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60517-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-991-2454
Provider Business Practice Location Address Fax Number:
630-991-2453
Provider Enumeration Date:
12/04/2014

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: 225100000X , with the licence number:  070.021207 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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