Basic Information
| Provider Information | |||||||||
| NPI: | 1881743920 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LORIN M. BROWN, M.D. P.C. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 45TH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463213917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199246544 | ||||||||
| FaxNumber: | 2199228502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 45TH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463213917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199246544 | ||||||||
| FaxNumber: | 2199228502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NEIS | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MED ASSISSTANT | ||||||||
| AuthorizedOfficialTelephone: | 2199246544 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00000008919 | 01 | IN | ANTHEM BCBS | OTHER |