Provider Demographics
NPI:1578524179
Name:BROWN, DAVID C JR (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6114
Mailing Address - Country:US
Mailing Address - Phone:269-375-0400
Mailing Address - Fax:269-372-8484
Practice Address - Street 1:6565 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-6114
Practice Address - Country:US
Practice Address - Phone:269-375-0400
Practice Address - Fax:269-372-8484
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2780626Medicaid
MI2780626Medicaid
MIOC96050013013Medicare ID - Type Unspecified