Provider Demographics
NPI:1144417098
Name:ANGELIQUE D. BROWN, M.D., P.C.
Entity Type:Organization
Organization Name:ANGELIQUE D. BROWN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-887-1340
Mailing Address - Street 1:6111 HARRISON ST
Mailing Address - Street 2:SUITE 331
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2969
Mailing Address - Country:US
Mailing Address - Phone:219-887-1340
Mailing Address - Fax:219-887-1518
Practice Address - Street 1:6111 HARRISON ST
Practice Address - Street 2:SUITE 331
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2969
Practice Address - Country:US
Practice Address - Phone:219-887-1340
Practice Address - Fax:219-887-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045570B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN207Q0000XOtherTAXONOMY #
IN01045570BOtherCONTROLLED SUBSTANCE #
IN01045570AOtherPHYSICIAN LICENSE
IN01045570AOtherPHYSICIAN LICENSE
IN165820Medicare PIN
ING46921Medicare UPIN