MEDICARE: JOHN MICHAEL BROWN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	01024033A	IN

General Provider Information

NPI Number	:	1851386486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MICHAEL BROWN M.D.

Provider Business Mailing Address
First Line	:	3920 ST FRANCIS WAY
Second Line	:	SUITE 100
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4917
Country	:	US
Telephone Number	:	765-428-5888
Fax Number	:	765-428-5897

Provider Business Practice Location Address
First Line	:	3920 ST FRANCIS WAY
Second Line	:	SUITE 100
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4917
Country	:	US
Telephone Number	:	765-428-5888
Fax Number	:	765-428-5897

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/08/2010

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