MEDICARE: MICHELLE DENISE BRISTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	1174216816	OH
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1174216816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DENISE BRISTER

Provider Business Mailing Address
First Line	:	12783 CEDAR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3359
Country	:	US
Telephone Number	:	216-278-6757
Fax Number	:

Provider Business Practice Location Address
First Line	:	14100 LAKE SHORE BLVD APT 304
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1941
Country	:	US
Telephone Number	:	216-278-6757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	06/07/2026

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Directions to “ MICHELLE DENISE BRISTER ” Practice Location

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