Provider Demographics
NPI:1194485896
Name:BROWN, MICHAEL DENNIS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DENNIS
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 DEPOT RD UNIT 12
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9432
Mailing Address - Country:US
Mailing Address - Phone:234-567-5545
Mailing Address - Fax:234-567-5545
Practice Address - Street 1:7716 DEPOT RD UNIT 12
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9432
Practice Address - Country:US
Practice Address - Phone:234-567-5545
Practice Address - Fax:234-567-5545
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator