Healthcare Provider Details

I. General information

NPI: 1619447802
Provider Name (Legal Business Name): BRANDON GERMANY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 ROCKSIDE RD STE 401
INDEPENDENCE OH
44131-2147
US

IV. Provider business mailing address

4401 ROCKSIDE RD STE 401
INDEPENDENCE OH
44131-2147
US

V. Phone/Fax

Practice location:
  • Phone: 216-543-0250
  • Fax:
Mailing address:
  • Phone: 216-543-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: