Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 35.094127 | OH |
N | 208000000X | Pediatrician | 35-094127 | OH |
N | 2084N0402X | Child Neurologist | 35.094127 | OH |
NPI | 1720293160 |
---|---|
Provider Name | Dr. Suzanne Denise Debrosse |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000725150 | ANTHEM (01) | |
0056505 | (05) | OH |
2048816199ER | CARESOURCE (01) | OH |
35.094127 | LICENSE (01) | OH |
609409 | WELLCARE (01) | OH |
9648753 | AETNA (01) |