Basic Information
| Provider Information | |||||||||
| NPI: | 1811935976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 MACK BLVD, SUITE 2 WEST | ||||||||
| Address2: | CREDENTIALING DEPT. | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134489006 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3901 CHRYSLER DR | ||||||||
| Address2: | SUITE 4A | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454525 | ||||||||
| FaxNumber: | 3135773777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301407047 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 4301407047 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.