Provider Demographics
NPI:1437273141
Name:BOYD BROWN, MADELINE (DO)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:BOYD BROWN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16150 MEYERS ROAD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-4107
Mailing Address - Country:US
Mailing Address - Phone:313-345-7940
Mailing Address - Fax:313-534-7796
Practice Address - Street 1:16150 MEYERS ROAD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4107
Practice Address - Country:US
Practice Address - Phone:313-345-7940
Practice Address - Fax:313-534-7796
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1876268Medicaid
MI0158210755OtherBCBS
MI1876268Medicaid
E33145Medicare UPIN