Individual
BRYAN J MICHELOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3733 PARK EAST DR, 107, BEACHWOOD, OH 44122-4338
(216) 595-6800
(216) 593-0414
Mailing address
3733 PARK EAST DR, 107, BEACHWOOD, OH 44122-4338
(216) 595-6800
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
35062842M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2019103
—
OH
Enumeration date
07/19/2006
Last updated
09/29/2015
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