Basic Information
| Provider Information | |||||||||
| NPI: | 1205858792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 EUCLID AVENUE/R3 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | CLEVELAND CLINIC 9500 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441951716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164451099 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 35-086339 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 208000000X | 35-086339 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0216X | 35-086339 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 7287047 | 01 | OH | AETNA | OTHER | 745885 | 01 | OH | BUCKEYE | OTHER | 000000368506 | 01 | OH | ANTHEM | OTHER | 000000525884 | 01 | OH | ANTHEM | OTHER | 2153851 | 01 | OH | BCMH | OTHER | 000000221208 | 01 | OH | UNISON | OTHER | 363382 | 01 | OH | WELLCARE | OTHER | 0017541850003 | 05 | PA | MEDICAID | 2153851 | 05 | OH | MEDICAID |