Provider Demographics
NPI:1669130712
Name:BROWN, CORTEX DEMEIKO
Entity type:Individual
Prefix:
First Name:CORTEX
Middle Name:DEMEIKO
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 1:815 N ONTARIO ST APT 50
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-3638
Mailing Address - Country:US
Mailing Address - Phone:419-212-8060
Mailing Address - Fax:
Practice Address - Street 1:815 N ONTARIO ST APT 50
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-3638
Practice Address - Country:US
Practice Address - Phone:419-212-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide