Healthcare Provider Details

I. General information

NPI: 1528030830
Provider Name (Legal Business Name): RUDY MARWAN ROUWEYHA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 W LIBERTY ST
HUBBARD OH
44425-1749
US

IV. Provider business mailing address

634 W LIBERTY ST
HUBBARD OH
44425-1749
US

V. Phone/Fax

Practice location:
  • Phone: 330-534-4442
  • Fax: 330-534-4446
Mailing address:
  • Phone: 330-534-4442
  • Fax: 330-534-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36002620R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: