Provider Demographics
NPI:1053440347
Name:ROUWEYHA, RENEE (PAC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ROUWEYHA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5595 TRANSPORTATION BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5359
Mailing Address - Country:US
Mailing Address - Phone:216-587-5431
Mailing Address - Fax:
Practice Address - Street 1:5595 TRANSPORTATION BLVD STE 220
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5359
Practice Address - Country:US
Practice Address - Phone:216-587-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001440363AM0700X, 363AS0400X
OH50.001440RX363A00000X
FLPA9107184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12689Medicare UPIN