MEDICARE: MRS. LISA A. BROWN PAC

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	363AS0400X	Surgical Physician Assistant	5601004300	MI

General Provider Information

NPI Number	:	1962552273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA A. BROWN PAC

Provider Business Mailing Address
First Line	:	106 E MAIN ST
Second Line	:
City	:	SEBEWAING
State	:	MI
Zip	:	48759-1568
Country	:	US
Telephone Number	:	989-883-3800
Fax Number	:	989-883-9131

Provider Business Practice Location Address
First Line	:	4497 SHEFFIELD PL
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2554
Country	:	US
Telephone Number	:	989-883-3800
Fax Number	:	989-883-9131

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	06/05/2012

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