Provider Demographics
NPI:1851695670
Name:BROWN, KENNETH D (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7354 CRACKLING CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4503
Mailing Address - Country:US
Mailing Address - Phone:248-417-7064
Mailing Address - Fax:248-849-2779
Practice Address - Street 1:7354 CRACKLING CREEK CIR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4503
Practice Address - Country:US
Practice Address - Phone:248-417-7064
Practice Address - Fax:248-849-2779
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-09
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001161213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist