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General NPI Number Information
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NPI Number | 1356932883
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Entity Type | Organization
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Legal Business Name | ASMSC-VALPARAISO IN PC
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Dates
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Enumeration Date | 01/28/2021
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 6445 E DIVISION RD
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City | MILL CREEK
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State | IN
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Zip | 46365-9798
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Country | US
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Telephone | 269-985-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 2570 NILES RD
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3203
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Country | US
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Telephone | 269-985-0021
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Fax | 269-281-0281
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Authorized Official
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Title or Position | OWNER, CEO, PRESIDENT
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Name | DR. CLARENCE W BROWN JR.
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Credential | MD, JD
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Telephone | 269-985-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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