Healthcare Provider Details

I. General information

NPI: 1548092455
Provider Name (Legal Business Name): MR. MARVIN LEE BROWN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8906 EMPIRE AVE
CLEVELAND OH
44108-2869
US

IV. Provider business mailing address

8906 EMPIRE AVE
CLEVELAND OH
44108-2869
US

V. Phone/Fax

Practice location:
  • Phone: 216-965-7055
  • Fax:
Mailing address:
  • Phone: 216-965-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: