Provider Demographics
NPI:1871773382
Name:BROWN, ANDREW RUSSELL (MA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RUSSELL
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2079
Mailing Address - Country:US
Mailing Address - Phone:517-279-8787
Mailing Address - Fax:517-279-6119
Practice Address - Street 1:43 S MICHIGAN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2079
Practice Address - Country:US
Practice Address - Phone:517-279-8787
Practice Address - Fax:517-279-6119
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000449231H00000X
MI3501002908237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383292831OtherTIN
MI0P54540001Medicare PIN