Healthcare Provider Details

I. General information

NPI: 1629067202
Provider Name (Legal Business Name): RANDY K. BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4870 E JACKSON ST
MUNCIE IN
47303-4432
US

IV. Provider business mailing address

2401 W UNIVERSITY AVE C/O GARNET E. KING, CARDINAL HEALTH SYSTEM, INC
MUNCIE IN
47303-3428
US

V. Phone/Fax

Practice location:
  • Phone: 765-284-7277
  • Fax: 765-284-7472
Mailing address:
  • Phone: 765-751-5269
  • Fax: 765-751-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01055804A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: