Healthcare Provider Details

I. General information

NPI: 1619026887
Provider Name (Legal Business Name): ELLA E M BROWN CHARITABLE CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 B DR N
ALBION MI
49224-8420
US

IV. Provider business mailing address

200 N MADISON ST
MARSHALL MI
49068-1143
US

V. Phone/Fax

Practice location:
  • Phone: 517-629-2134
  • Fax:
Mailing address:
  • Phone: 269-781-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE DESMET
Title or Position: FINANCIAL PLANNING & REIMBURSEMENT
Credential:
Phone: 269-781-4271