Healthcare Provider Details

I. General information

NPI: 1912700386
Provider Name (Legal Business Name): KEVIN JOSEPH BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MEDICAL CENTER DR
COLUMBUS OH
43210-1229
US

IV. Provider business mailing address

480 MEDICAL CENTER DR
COLUMBUS OH
43210-1229
US

V. Phone/Fax

Practice location:
  • Phone: 567-395-3322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1912700386
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: