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General NPI Number Information
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NPI Number | 1134200132
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Entity Type | Organization
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Legal Business Name | JACK RZEPKA, M.D., INC.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 4200 WARRENSVILLE CENTER RD SUITE 420
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City | BEACHWOOD
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State | OH
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Zip | 44122-7051
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Country | US
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Telephone | 216-752-9055
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Fax | 216-752-0990
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Provider Business Mailing Address
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Address Line | 4200 WARRENSVILLE CENTER RD SUITE 420
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City | BEACHWOOD
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State | OH
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Zip | 44122-7051
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Country | US
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Telephone | 216-752-9055
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Fax | 216-752-0990
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK RZEPKA
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Credential | M.D.
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Telephone | 216-752-9055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-051524R
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License Number State | OH
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