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Individual

WENDY THOMAS BROWN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828

Taxonomy

Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
0101052989
VA
2085P0229X
Pediatric Radiology Physician
Primary
4301501891
MI
2085R0202X
Diagnostic Radiology Physician
0101052989
VA
2085R0202X
Diagnostic Radiology Physician
40286
TN
2085R0202X
Diagnostic Radiology Physician
4301501891
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10110018
OPTIMA HEALTH PLAN
VA
01
1053398412
VA PREMIER HEALTH PLAN
VA
05
1053398412
NC
05
1053398412
VA
01
139178
BCBSVA
VA
01
180AF
BCBSNC
NC
01
5512875
AETNA HEALTHCARE
VA
01
P01206178
RAILROAD MEDICARE
VA
Enumeration date
12/28/2005
Last updated
07/29/2020
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