Provider Demographics
NPI:1659363299
Name:BROWN, MELODIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:MELODIE
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14705 W UPRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1949
Mailing Address - Country:US
Mailing Address - Phone:231-547-1308
Mailing Address - Fax:231-392-7332
Practice Address - Street 1:14705 W UPRIGHT ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1949
Practice Address - Country:US
Practice Address - Phone:231-547-1308
Practice Address - Fax:231-392-7332
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMB070397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4218748Medicaid
MI4218748Medicaid