Provider Demographics
NPI:1922629674
Name:BROWN, MICHAEL BAKER (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BAKER
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4340 LADSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6444
Mailing Address - Country:US
Mailing Address - Phone:843-851-9069
Mailing Address - Fax:
Practice Address - Street 1:119 BERKLEY RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08020-1161
Practice Address - Country:US
Practice Address - Phone:856-599-0133
Practice Address - Fax:833-234-1751
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC752213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist