Provider Demographics
NPI:1629067202
Name:BROWN, RANDY K (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:K
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2401 W UNIVERSITY AVE
Mailing Address - Street 2:C/O GARNET E. KING, CARDINAL HEALTH SYSTEM, INC
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3428
Mailing Address - Country:US
Mailing Address - Phone:765-751-5269
Mailing Address - Fax:765-751-2759
Practice Address - Street 1:4870 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4432
Practice Address - Country:US
Practice Address - Phone:765-284-7277
Practice Address - Fax:765-284-7472
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01055804A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000370508OtherANTHEM
IN226200VMedicare ID - Type Unspecified
H80077Medicare UPIN