Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 35047209 | OH |
NPI | 1629064431 |
---|---|
Provider Name | Robert Martin Rennebohm |
First Address | Cleveland, OH 44195 |
Second Address | Cleveland, OH 44195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 03/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105434000 | (05) | WV |
0478531 | (05) | OH |
64789407 | (05) | KY |
A82843 | (02) |