Healthcare Provider Details

I. General information

NPI: 1659144889
Provider Name (Legal Business Name): MEREDITH C HLEBAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEREDITH REINHARD PA-C

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N LAKE ST
MADISON OH
44057-3152
US

IV. Provider business mailing address

5835 ROYAL DR
WILLOUGHBY OH
44094-3049
US

V. Phone/Fax

Practice location:
  • Phone: 440-428-7511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008378RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: