Provider Demographics
NPI:1003865304
Name:BROWN, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 DUTCHMANS LN, SUITE #3A
Mailing Address - Street 2:SUBURBAN PLAZA ONE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4714
Mailing Address - Country:US
Mailing Address - Phone:502-897-7300
Mailing Address - Fax:502-897-3332
Practice Address - Street 1:3999 DUTCHMANS LN, SUITE #3A
Practice Address - Street 2:SUBURBAN PLAZA ONE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4714
Practice Address - Country:US
Practice Address - Phone:502-897-7300
Practice Address - Fax:502-897-3332
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35789207Y00000X
IN01058901A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200483440AMedicaid
KY2445466000OtherPASSPORT ADVANTAGE #
IN000000335350OtherINDIANA ANTHEM NUMBER
P00163950OtherRAILROAD MEDICARE NUMBER
KY64078066Medicaid
7063240OtherCIGNA
KY000000335350OtherKENTUCKY ANTHEM NUMBER
IN200458400OtherINDIANA GROUP MEDICAID #
7455590OtherAETNA
KY50004083OtherKENTUCKY PASSPORT #
IN200483440AMedicaid
IN212460CMedicare PIN
KY64078066Medicaid
KY0655203Medicare PIN
7455590OtherAETNA
KYI05792Medicare UPIN