Provider Demographics
NPI:1720293160
Name:DEBROSSE, SUZANNE DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:DENISE
Last Name:DEBROSSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:LAKESIDE 1500
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3936
Practice Address - Fax:216-844-7497
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-094127208000000X
OH35.0941272084N0402X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000725150OtherANTHEM
OH35.094127OtherLICENSE
9648753OtherAETNA
OH609409OtherWELLCARE
OH0056505Medicaid
OH2048816199EROtherCARESOURCE
OHH015700Medicare PIN