Provider Demographics
NPI:1811935976
Name:BROWN, PATRICIA DIANE (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 MACK BLVD, SUITE 2 WEST
Mailing Address - Street 2:CREDENTIALING DEPT.
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-448-9006
Mailing Address - Fax:
Practice Address - Street 1:3901 CHRYSLER DR
Practice Address - Street 2:SUITE 4A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2167
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-577-3777
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407047207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630456Medicare PIN