Healthcare Provider Details

I. General information

NPI: 1407241474
Provider Name (Legal Business Name): JOSEPH RABE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 WARRINGTON RD
SHAKER HEIGHTS OH
44120-2424
US

IV. Provider business mailing address

7609 HEMPFIELD LN
HUDSON OH
44236-5218
US

V. Phone/Fax

Practice location:
  • Phone: 314-488-8108
  • Fax:
Mailing address:
  • Phone: 314-488-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.139829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: