Healthcare Provider Details

I. General information

NPI: 1114928900
Provider Name (Legal Business Name): BERT M. BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 MAYFIELD ROAD SUITE 210
MAYFIELD HTS OH
44124
US

IV. Provider business mailing address

6770 MAYFIELD RD SUITE 210
MAYFIELD HEIGHTS OH
44124-2299
US

V. Phone/Fax

Practice location:
  • Phone: 440-461-0150
  • Fax: 440-461-8221
Mailing address:
  • Phone: 440-461-0150
  • Fax: 440-461-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35-05-6634
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: