Healthcare Provider Details

I. General information

NPI: 1538246087
Provider Name (Legal Business Name): DAPHINE ANN BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 GREENFIELD RD SUITE 306
SOUTHFIELD MI
48075-5347
US

IV. Provider business mailing address

23060 REPUBLIC AVE SUITE 107
OAK PARK MI
48237-2347
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-9641
  • Fax: 248-569-9643
Mailing address:
  • Phone: 248-541-3536
  • Fax: 248-545-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301064587
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: