Provider Demographics
NPI:1457497927
Name:BROWN, CAROL MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3205 S ANN LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53146-2320
Mailing Address - Country:US
Mailing Address - Phone:262-548-0029
Mailing Address - Fax:262-521-3005
Practice Address - Street 1:8825 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3760
Practice Address - Country:US
Practice Address - Phone:414-764-0920
Practice Address - Fax:414-764-8134
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI20848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20848OtherSTATE LICENSE NUMBER
WIB51769Medicare UPIN