MEDICARE: KEVIN DANIEL BROWN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	10004235A	IN
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1871204776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN DANIEL BROWN PA-C

Provider Business Mailing Address
First Line	:	5103 N CONTI CT
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47404-9055
Country	:	US
Telephone Number	:	813-758-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 UNIVERSITY BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5147
Country	:	US
Telephone Number	:	317-274-5555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/21/2023

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