Provider Demographics
NPI:1801652136
Name:BREWER, KEITH
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:BREWER
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 1:12027 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3742
Mailing Address - Country:US
Mailing Address - Phone:330-824-1773
Mailing Address - Fax:
Practice Address - Street 1:12027 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3742
Practice Address - Country:US
Practice Address - Phone:330-824-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist