Individual
KYLE R BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
540 SAYBROOK RD, SUITE 160, MIDDLETOWN, CT 06457-4711
(860) 685-8940
(860) 685-8947
Mailing address
31 E MAIN ST, BRANFORD, CT 06405-3707
(203) 481-5303
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
001574
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290001574CT01
BLUE SHIELD PROVIDER NUMB
CT
01
—
747653
CONNECTICARE PROVIDER NUM
CT
Enumeration date
07/13/2005
Last updated
07/09/2007
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