Provider Demographics
NPI:1770553166
Name:BROWN, ANGELIQUE D (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8777 BROADWAY
Mailing Address - Street 2:SUITE 331
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6693
Mailing Address - Country:US
Mailing Address - Phone:219-738-3854
Mailing Address - Fax:219-738-3864
Practice Address - Street 1:6111 HARRISON ST
Practice Address - Street 2:SUITE 331
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2969
Practice Address - Country:US
Practice Address - Phone:219-887-1340
Practice Address - Fax:219-887-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01045570A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN207Q0000XOtherTAXONOMY CODE
IN15D0938335OtherCLIA #
IN01045570AOtherPHYSICIAN'S LICENSE #
IN200098750BMedicaid
IN01045570BOtherCONTROLLED SUBSTANCE #
INBB6906006OtherDEA #
INBB6906006OtherDEA #
IN200098750BMedicaid