=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114720844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RPM OH CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2025
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 154 CENTENNIAL DR
-----------------------------------------------------
City | AVON LAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44012-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-281-7264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4355 WEAVER PKWY STE 320
-----------------------------------------------------
City | WARRENVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60555-4052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | FAISAL KHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-327-9065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------