Provider Demographics
NPI:1932669827
Name:BROWN, DONALD (CPRM)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:CPRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18582 GODDARD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1319
Mailing Address - Country:US
Mailing Address - Phone:313-285-0718
Mailing Address - Fax:
Practice Address - Street 1:18582 GODDARD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1319
Practice Address - Country:US
Practice Address - Phone:313-285-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM00340175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist