Provider Demographics
NPI:1528030830
Name:ROUWEYHA, RUDY MARWAN (DPM)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:MARWAN
Last Name:ROUWEYHA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1749
Mailing Address - Country:US
Mailing Address - Phone:330-534-4442
Mailing Address - Fax:330-534-4446
Practice Address - Street 1:634 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1749
Practice Address - Country:US
Practice Address - Phone:330-534-4442
Practice Address - Fax:330-534-4446
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002620R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0822953Medicaid
OHRO0694362Medicare PIN
OH5965490001Medicare NSC
OH0822953Medicaid
OHH083450Medicare PIN