Provider Demographics
NPI:1912772948
Name:BROWN, LAVELL ALLEN
Entity Type:Individual
Prefix:
First Name:LAVELL
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15322 SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1926
Mailing Address - Country:US
Mailing Address - Phone:313-999-2253
Mailing Address - Fax:313-324-8901
Practice Address - Street 1:1145 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2336
Practice Address - Country:US
Practice Address - Phone:313-324-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist