Provider Demographics
NPI:1538246087
Name:BROWN, DAPHINE ANN (MD)
Entity type:Individual
Prefix:
First Name:DAPHINE
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23060 REPUBLIC AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2347
Mailing Address - Country:US
Mailing Address - Phone:248-541-3536
Mailing Address - Fax:248-545-8506
Practice Address - Street 1:20905 GREENFIELD RD
Practice Address - Street 2:SUITE 306
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5347
Practice Address - Country:US
Practice Address - Phone:248-569-9641
Practice Address - Fax:248-569-9643
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064587208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4477866 TYPE 10Medicaid
MI4477866 TYPE 10Medicaid
MI0N66130Medicare PIN