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General NPI Number Information
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NPI Number | 1861795213
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Entity Type | Organization
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Legal Business Name | BROOKS MED GROUP CO
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 815 SUPERIOR AVE E
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City | CLEVELAND
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State | OH
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Zip | 44114-2706
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Country | US
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Telephone | 216-924-6084
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Fax |
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Provider Business Mailing Address
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Address Line | 815 SUPERIOR AVE E
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City | CLEVELAND
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State | OH
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Zip | 44114-2706
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT CALDEMEYER
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Credential |
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Telephone | 216-924-6084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.051718
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License Number State | OH
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