Healthcare Provider Details

I. General information

NPI: 1629064431
Provider Name (Legal Business Name): ROBERT MARTIN RENNEBOHM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE CRILE BLDG. DESK AIII CLEVELAND CLINIC
CLEVELAND OH
44195
US

IV. Provider business mailing address

9500 EUCLID AVE CRILE BLDG. DESK AIII CLEVELAND CLINIC
CLEVELAND OH
44195
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-6626
  • Fax: 216-445-3797
Mailing address:
  • Phone: 216-445-6626
  • Fax: 216-445-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number35047209
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: