=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255459160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDRA BROWN M.D.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 02/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23077 GREENFIELD RD SUITE #235
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-3709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-557-1414
-----------------------------------------------------
Fax | 248-557-2708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23077 GREENFIELD RD SUITE #235
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-3709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-557-1414
-----------------------------------------------------
Fax | 248-557-2708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAN
-----------------------------------------------------
Name | DR. SANDRA EILEEN BROWN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 248-557-1414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 4301045361
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------