Provider Demographics
NPI:1487138103
Name:BROWN, MICHAEL DAVID JR (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 HILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3610
Mailing Address - Country:US
Mailing Address - Phone:502-551-9527
Mailing Address - Fax:
Practice Address - Street 1:4221 HILLBROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3610
Practice Address - Country:US
Practice Address - Phone:502-551-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1136068163W00000X
KY3013017367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse