Provider Demographics
NPI:1457313926
Name:BROWN, HAROLD E (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:E
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 1:804 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-1444
Mailing Address - Country:US
Mailing Address - Phone:269-695-3897
Mailing Address - Fax:269-695-0460
Practice Address - Street 1:804 E FRONT ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-1444
Practice Address - Country:US
Practice Address - Phone:269-695-3897
Practice Address - Fax:269-695-0460
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI011058481OtherMEDICARE RAILROAD
MI152141OtherFAA AIR
MI1045188Medicaid
MIP57103OtherBLUE CARE NETWORK
MI0101119015OtherBLUE CROSS/BLUE SHIELD
MIA78246Medicare UPIN
MI0N80940Medicare ID - Type UnspecifiedMEDICARE GROUP #
MI1045188Medicaid