Provider Demographics
NPI:1689647406
Name:BROWNELL, CARYN A (MD)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:A
Last Name:BROWNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:N17 W24100 RIVERWOOD DRIVE
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:2130 BIG BEND ROAD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7624
Practice Address - Country:US
Practice Address - Phone:262-928-7555
Practice Address - Fax:262-513-7575
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI32263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31752200Medicaid
WI683750588Medicare PIN
WI000268580Medicare PIN
WI31752200Medicaid