MEDICARE: DAVID M BRILL DO

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	207Q00000X	Family Medicine Physician	34004484	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000502409	OTHER	OH	ANTHEM BC/BS
2	341542312147	OTHER	OH	CARESOURCE
3	P00705913	OTHER	OH	RAILROAD CARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811096746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M BRILL DO

Provider Business Mailing Address
First Line	:	19324 DETROIT RD
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-1802
Country	:	US
Telephone Number	:	440-356-3640
Fax Number	:	440-356-3729

Provider Business Practice Location Address
First Line	:	19324 DETROIT RD
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-1802
Country	:	US
Telephone Number	:	440-356-3640
Fax Number	:	440-356-3729

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	06/26/2009

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Directions to “ DAVID M BRILL DO” Practice Location

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