Healthcare Provider Details

I. General information

NPI: 1427233279
Provider Name (Legal Business Name): VEGAS BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR DEPT OF EMERGENCY MEDICINE
DETROIT MI
48235-2624
US

IV. Provider business mailing address

6071 W OUTER DR
DETROIT MI
48235-2624
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-1020
  • Fax:
Mailing address:
  • Phone: 313-966-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301086373
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: