MEDICARE: DR. PAUL RITENOUR DO

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	174400000X	Specialist
2	207R00000X	Internal Medicine Physician	34.006501	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598726028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL RITENOUR DO

Provider Business Mailing Address
First Line	:	43 E 4TH ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44902-1303
Country	:	US
Telephone Number	:	419-571-5290
Fax Number	:	419-522-0998

Provider Business Practice Location Address
First Line	:	43 E 4TH ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44902-1303
Country	:	US
Telephone Number	:	419-571-5290
Fax Number	:	419-522-0998

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

Provider Enumeration Date	:	04/02/2006
Last Update Date	:	06/10/2015

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