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1720293160

NPI Code Detail

MEDICARE: DR. SUZANNE DENISE DEBROSSE M.D.

MEDICARE: DR. SUZANNE DENISE DEBROSSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35-094127	OH
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	35.094127	OH
3	207SG0201X	Clinical Genetics (M.D.) Physician	35.094127	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000725150	OTHER		ANTHEM
2	35.094127	OTHER	OH	LICENSE
3	9648753	OTHER		AETNA
4	609409	OTHER	OH	WELLCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2048816199ER	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1720293160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE DENISE DEBROSSE M.D.

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:	LAKESIDE 1500
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-3936
Fax Number	:	216-844-7497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	12/09/2020

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Directions to “ DR. SUZANNE DENISE DEBROSSE M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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