Provider Demographics
NPI:1114928900
Name:BROWN, BERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:M
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6770 MAYFIELD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:440-461-0150
Mailing Address - Fax:440-461-8221
Practice Address - Street 1:6770 MAYFIELD ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-461-0150
Practice Address - Fax:440-461-8221
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-05-6634207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH026830OtherMEDICARE PTAN
OH0711073Medicaid
OHH026830OtherMEDICARE PTAN