Provider Demographics
NPI:1578786125
Name:O WILLIAM BROWN MD PC
Entity Type:Organization
Organization Name:O WILLIAM BROWN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-433-0881
Mailing Address - Street 1:31700 TELEGRAPH RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3407
Mailing Address - Country:US
Mailing Address - Phone:248-433-0881
Mailing Address - Fax:
Practice Address - Street 1:31700 TELEGRAPH RD
Practice Address - Street 2:SUITE 140
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-3407
Practice Address - Country:US
Practice Address - Phone:248-433-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010434962086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2115358Medicaid
MIBLUE CROSSOther0206353071
MI=========OtherTAX ID
MI0M87120Medicare ID - Type Unspecified
A75924Medicare UPIN