Healthcare Provider Details

I. General information

NPI: 1194652917
Provider Name (Legal Business Name): MICHAEL BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 BASS LAKE RD STE 255
NEW HOPE MN
55428-3019
US

IV. Provider business mailing address

9220 BASS LAKE RD STE 255
NEW HOPE MN
55428-3019
US

V. Phone/Fax

Practice location:
  • Phone: 612-346-7694
  • Fax:
Mailing address:
  • Phone: 612-346-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34011
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: