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General NPI Number Information
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NPI Number | 1871204776
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Entity Type | Individual
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Provider Name | KEVIN DANIEL BROWN PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 420 UNIVERSITY BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5147
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Country | US
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Telephone | 317-274-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 5103 N CONTI CT
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City | BLOOMINGTON
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State | IN
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Zip | 47404-9055
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Country | US
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Telephone | 813-758-8106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10004235A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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