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General NPI Number Information
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NPI Number | 1225563661
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Entity Type | Individual
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Provider Name | ELIZABETH ANN RAINBOLT
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Gender | Female
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 14601 DETROIT AVE FL 2
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City | LAKEWOOD
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State | OH
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Zip | 44107
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Country | US
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Telephone | 216-237-5500
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Fax | 216-237-5670
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Provider Business Mailing Address
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Address Line | 4312 W 211TH ST
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-1509
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Country | US
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Telephone | 216-956-8709
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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 | 35.139838
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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 | 57.029942
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License Number State | OH
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