Healthcare Provider Details

I. General information

NPI: 1710246715
Provider Name (Legal Business Name): MICHAEL CHASE BROWN CPO/LPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JAMES CASEY ST STE 1C
AUSTIN TX
78745-1120
US

IV. Provider business mailing address

4310 JAMES CASEY ST STE 1C
AUSTIN TX
78745-1120
US

V. Phone/Fax

Practice location:
  • Phone: 512-916-9431
  • Fax: 512-916-9435
Mailing address:
  • Phone: 512-916-9431
  • Fax: 512-916-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number1322
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1322
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: