Healthcare Provider Details

I. General information

NPI: 1770553166
Provider Name (Legal Business Name): ANGELIQUE D BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 HARRISON ST SUITE 331
MERRILLVILLE IN
46410-2969
US

IV. Provider business mailing address

8777 BROADWAY SUITE 331
MERRILLVILLE IN
46410-6693
US

V. Phone/Fax

Practice location:
  • Phone: 219-887-1340
  • Fax: 219-887-1518
Mailing address:
  • Phone: 219-738-3854
  • Fax: 219-738-3864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01045570A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: