Healthcare Provider Details

I. General information

NPI: 1528395852
Provider Name (Legal Business Name): BRANDON LEE PRENDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # DESKA71
CLEVELAND OH
44195-1714
US

IV. Provider business mailing address

9500 EUCLID AVE # DESKA71
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-0578
  • Fax:
Mailing address:
  • Phone: 216-444-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number35.123814
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: