Healthcare Provider Details

I. General information

NPI: 1306286919
Provider Name (Legal Business Name): ALEXANDER RICHARD BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 LAKE SHORE DR
CHARLEVOIX MI
49720-1931
US

IV. Provider business mailing address

4428 WEATHERWOOD DR
TRAVERSE CITY MI
49685-8260
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-4024
  • Fax: 801-740-2847
Mailing address:
  • Phone: 231-632-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301103064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: