Healthcare Provider Details

I. General information

NPI: 1528066461
Provider Name (Legal Business Name): THOMAS M BROWN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE STE 400
LANSING MI
48912-1806
US

IV. Provider business mailing address

3301 E MICHIGAN AVE STE A
LANSING MI
48912-4641
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9650
  • Fax: 517-364-9605
Mailing address:
  • Phone: 517-253-3633
  • Fax: 517-253-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101011818
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: