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General NPI Number Information
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NPI Number | 1609444074
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Entity Type | Individual
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Provider Name | BRANDON A. PROWELL CERTIFIEDHAIRLOSSSPE
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Gender | Male
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 6505 MAYFIELD RD STE 1062
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-3216
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Country | US
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Telephone | 216-413-9250
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Fax |
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Provider Business Mailing Address
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Address Line | 34 LEXINGTON SQ
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City | EUCLID
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State | OH
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Zip | 44143-2417
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Country | US
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Telephone | 216-965-5895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | COS.165572
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | COS.165572
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License Number State | OH
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