Provider Demographics
NPI:1811034457
Name:BROWN, DENNIS GREGORY (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GREGORY
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2901 W KINNICKINNIC RIVER PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3660
Mailing Address - Country:US
Mailing Address - Phone:414-671-1596
Mailing Address - Fax:414-671-0536
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:SUITE 317
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3677
Practice Address - Country:US
Practice Address - Phone:414-671-1596
Practice Address - Fax:414-671-0536
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22977225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30474800Medicaid
WI02265Medicare ID - Type Unspecified
WIB51770Medicare UPIN