Provider Demographics
NPI:1568569234
Name:BROWN, KELLY Z (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:Z
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1941 BISHOP LN STE 1018
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1928
Mailing Address - Country:US
Mailing Address - Phone:502-456-6211
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1220 MISSOURI AVE
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3725
Practice Address - Country:US
Practice Address - Phone:812-283-2169
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01049440207ZP0102X
KY30049207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50015821OtherPASSPORT
KY2873452000OtherPASSPORT ADVANTAGE
KYP00709200OtherMEDICARE RR
IN000000526547OtherANTHEM
IN200206660AMedicaid
KY64017668Medicaid
INP00430449OtherMEDICARE RR
KY2873452000OtherPASSPORT ADVANTAGE
KYP00709200OtherMEDICARE RR
IN251820AMedicare PIN