Healthcare Provider Details

I. General information

NPI: 1790753432
Provider Name (Legal Business Name): DENNIS BENJAMIN REPENNING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30680 BAINBRIDGE RD COMMUNITY HOSPITALISTS
CLEVELAND OH
44139-2282
US

IV. Provider business mailing address

630 E RIVER ST
ELYRIA OH
44035-5902
US

V. Phone/Fax

Practice location:
  • Phone: 440-542-5023
  • Fax:
Mailing address:
  • Phone: 440-329-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-086072
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: