Provider Demographics
NPI:1306870415
Name:BROWNE, MARIA THERESA ORTIZ (MD)
Entity type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:ORTIZ
Last Name:BROWNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA THERESA
Other - Middle Name:DOLENDO
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:206 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1512
Mailing Address - Country:US
Mailing Address - Phone:810-229-8511
Mailing Address - Fax:810-229-7560
Practice Address - Street 1:206 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1512
Practice Address - Country:US
Practice Address - Phone:810-229-8511
Practice Address - Fax:810-229-7560
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081064207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI597735OtherMCARE
MI0470127OtherBLUE CARE NETWORK
MI436523OtherCARE CHOICES
MI5606268Medicaid
MI08-0-47-0127-1OtherBLUE CROSS BLUE SHIELD
MI597735OtherAETNA
MI5606268Medicaid
MI0470127OtherBLUE CARE NETWORK