Provider Demographics
NPI:1174516744
Name:BROWN, ALBERT C (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5237 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-8624
Mailing Address - Country:US
Mailing Address - Phone:231-267-9761
Mailing Address - Fax:
Practice Address - Street 1:419 W STATE ST
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659
Practice Address - Country:US
Practice Address - Phone:231-587-9181
Practice Address - Fax:231-587-0923
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB069428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4190772Medicaid
MION83490Medicare ID - Type Unspecified
MI4190772Medicaid