MEDICARE: CLEVELAND EAR NOSE THROAT AND ALLERGY CENTER INC

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	207Y00000X	Otolaryngology Physician		OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH5776	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396746921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND EAR NOSE THROAT AND ALLERGY CENTER INC

Provider Business Mailing Address
First Line	:	P.O. BOX 72591
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44192
Country	:	US
Telephone Number	:	216-662-3711
Fax Number	:	216-662-5139

Provider Business Practice Location Address
First Line	:	5400 TRANSPORTATION BLVD
Second Line	:	SUITE 8
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5324
Country	:	US
Telephone Number	:	216-662-3711
Fax Number	:	216-662-5139

Authorized Official
Title or Position	:	PRESIDENT, CLEVELAND EAR NOSE THROA
Name	:	BERT BROWN
Credential	:	M.D.
Telephone Number	:	216-662-3711

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	07/21/2022

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