Healthcare Provider Details

I. General information

NPI: 1720540636
Provider Name (Legal Business Name): BRADY KAHLIG OTTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/06/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33100 CLEVELAND CLINIC BLVD
AVON OH
44011-1390
US

IV. Provider business mailing address

2075 W 25TH ST APT 710
CLEVELAND OH
44113-4152
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL87960
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.154455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: