Healthcare Provider Details

I. General information

NPI: 1720205610
Provider Name (Legal Business Name): MICHAEL BRONIATOWSKI M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 E 22ND ST SUITE 200
CLEVELAND OH
44115-3176
US

IV. Provider business mailing address

4758 RIDGE RD #161
CLEVELAND OH
44144-3327
US

V. Phone/Fax

Practice location:
  • Phone: 440-363-2556
  • Fax: 440-363-2768
Mailing address:
  • Phone: 440-236-8484
  • Fax: 440-236-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35-043656
License Number StateOH

VIII. Authorized Official

Name: MICHAEL BRONIATOWSKI
Title or Position: OWNER
Credential: M.D
Phone: 216-363-2556