Healthcare Provider Details

I. General information

NPI: 1366448680
Provider Name (Legal Business Name): BRYAN DEWITT CALDWELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 EUCLID AVE STE 110
CLEVELAND OH
44103-3759
US

IV. Provider business mailing address

4415 EUCLID AVE STE 110
CLEVELAND OH
44103-3759
US

V. Phone/Fax

Practice location:
  • Phone: 216-231-5612
  • Fax: 216-721-5534
Mailing address:
  • Phone: 216-231-5612
  • Fax: 216-721-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36 002681
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: