Provider Demographics
NPI:1255710596
Name:BACKOFF, BRADLEY BRENNAN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:BRENNAN
Last Name:BACKOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13719 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3439
Mailing Address - Country:US
Mailing Address - Phone:216-307-3005
Mailing Address - Fax:216-710-5360
Practice Address - Street 1:13719 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3439
Practice Address - Country:US
Practice Address - Phone:216-307-3005
Practice Address - Fax:216-710-5360
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003887213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery