Provider Demographics
NPI:1538656830
Name:CLEVELAND, BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1710
Mailing Address - Country:US
Mailing Address - Phone:651-999-6800
Mailing Address - Fax:833-905-0989
Practice Address - Street 1:6025 LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1710
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:833-905-0989
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74304208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology