Basic Information
| Provider Information | |||||||||
| NPI: | 1023066016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWNLEE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 SPRINGSIDE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443334549 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 13951 TERRACE RD | ||||||||
| Address2: | |||||||||
| City: | EAST CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441124308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167613300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 11/21/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35-074364 | OH | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2119200 | 05 | OH | MEDICAID |