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NPI Code Detail

MEDICARE: DR. JOHNATHON RERUCHA MD, MPH

MEDICARE: DR. JOHNATHON RERUCHA MD, MPH
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
1207P00000XEmergency Medicine Physician4301518283MI
2207P00000XEmergency Medicine Physician35.154400OH

General Provider Information

NPI Number : 1639864283
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHNATHON RERUCHA MD, MPH
Provider Business Mailing Address
First Line : 5923 RENAISSANCE PL
Second Line :
City : TOLEDO
State : OH
Zip : 43623-4709
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2142 N COVE BLVD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-3895
Country : US
Telephone Number : 419-291-4101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2023
Last Update Date : 06/22/2026

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