Healthcare Provider Details

I. General information

NPI: 1689834335
Provider Name (Legal Business Name): ERICK MICHAEL BROWN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 STATE LINE RD STE. 380
LEAWOOD KS
66206-1960
US

IV. Provider business mailing address

8900 STATE LINE RD STE. 380
LEAWOOD KS
66206-1960
US

V. Phone/Fax

Practice location:
  • Phone: 913-385-7252
  • Fax: 913-385-2412
Mailing address:
  • Phone: 913-385-7252
  • Fax: 913-385-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number05-35325
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2012007494
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: