Provider Demographics
NPI:1790793941
Name:BROWN, MEIUTTENUN CHONG MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MEIUTTENUN
Middle Name:CHONG MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 OLD 13 MILE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2171
Mailing Address - Country:US
Mailing Address - Phone:586-558-6990
Mailing Address - Fax:586-558-6996
Practice Address - Street 1:8200 OLD 13 MILE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2171
Practice Address - Country:US
Practice Address - Phone:586-558-6990
Practice Address - Fax:586-558-6996
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088766207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104918880Medicaid
MI104918906Medicaid
MI700H248710OtherBLUE CROSS GROUP NUMBER
MI104918890Medicaid
MI104918915Medicaid
MI104918871Medicaid
MI104918871Medicaid
MI0M69920017Medicare PIN