MEDICARE: RENEE ROUWEYHA PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	50001440	OH
2	363A00000X	Physician Assistant	50.001440RX	OH
3	363A00000X	Physician Assistant	PA9107184	FL
4	363AS0400X	Surgical Physician Assistant	50001440	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053440347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE ROUWEYHA PAC

Provider Business Mailing Address
First Line	:	5595 TRANSPORTATION BLVD STE 220
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5359
Country	:	US
Telephone Number	:	216-587-5431
Fax Number	:

Provider Business Practice Location Address
First Line	:	5595 TRANSPORTATION BLVD STE 220
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5359
Country	:	US
Telephone Number	:	216-587-5431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/12/2023

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Directions to “ RENEE ROUWEYHA PAC” Practice Location

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