Provider Demographics
NPI:1871536128
Name:MICHELLE R BROWN M.D. P.A.
Entity type:Organization
Organization Name:MICHELLE R BROWN M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-269-5000
Mailing Address - Street 1:PO BOX 782948
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-2948
Mailing Address - Country:US
Mailing Address - Phone:316-263-5889
Mailing Address - Fax:
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-263-5889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110556OtherBCBS
KS110556Medicare ID - Type Unspecified