Provider Demographics
NPI:1639396757
Name:BROWN, NICHOLAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 N HILLSIDE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4923
Mailing Address - Country:US
Mailing Address - Phone:316-263-0296
Mailing Address - Fax:
Practice Address - Street 1:551 N HILLSIDE ST STE 201
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4923
Practice Address - Country:US
Practice Address - Phone:316-263-0296
Practice Address - Fax:316-263-9523
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33893208600000X
KS6521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery