MEDICARE: JACK RZEPKA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35-05-1524-R	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000503638	OTHER	OH	ANTHEM BLUE SHIELD
2	000000536387	OTHER	OH	ANTHEM BLUE SHIELD
3	2350992	OTHER	OH	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306839790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK RZEPKA M.D.

Provider Business Mailing Address
First Line	:	4200 WARRENSVILLE CENTER RD
Second Line	:	SUITE 420
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-7051
Country	:	US
Telephone Number	:	216-752-9055
Fax Number	:	216-752-0990

Provider Business Practice Location Address
First Line	:	4200 WARRENSVILLE CENTER RD
Second Line	:	SUITE 420
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-7051
Country	:	US
Telephone Number	:	216-752-9055
Fax Number	:	216-752-0990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	02/28/2008

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Directions to “ JACK RZEPKA M.D.” Practice Location

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