Provider Demographics
NPI:1558362749
Name:BROWN, CARL A (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3711
Mailing Address - Country:US
Mailing Address - Phone:612-871-1144
Mailing Address - Fax:612-871-2012
Practice Address - Street 1:2211 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3711
Practice Address - Country:US
Practice Address - Phone:612-871-1144
Practice Address - Fax:612-871-2012
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21488207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32062600OtherMEDICAID - WISCONSIN
MN10-01991OtherMEDICA CHOICE
MN02094BROtherBLUE CROSS
IA0962217Other0962217
MN100643OtherUCARE
MN009897300Medicaid
MN88310OtherAMERICA'S PPO
MN0002528OtherPREFERREDONE
MN10-00010OtherMEDICA PRIMARY
MN02094BROtherBLUE CROSS
IA0962217Other0962217