Provider Demographics
NPI:1679258339
Name:BROWN, ODELL C
Entity Type:Individual
Prefix:
First Name:ODELL
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAKELAND MEDICAL BUILDING
Mailing Address - Street 2:25701 N LAKELAND BLVD STE 403
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132
Mailing Address - Country:US
Mailing Address - Phone:216-273-7000
Mailing Address - Fax:
Practice Address - Street 1:LAKELAND MEDICAL BUILDING
Practice Address - Street 2:25701 N LAKELAND BLVD STE 403
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132
Practice Address - Country:US
Practice Address - Phone:216-273-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator