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General NPI Number Information
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NPI Number | 1073831335
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Entity Type | Individual
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Provider Name | ELENEE RAUDENBUSH D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-5108
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Country | US
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Telephone | 216-444-5163
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-5108
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Country | US
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Telephone | 216-444-5163
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 58. 003183
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 276118
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.010671
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License Number State | OH
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