Provider Demographics
NPI:1629064431
Name:RENNEBOHM, ROBERT MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:RENNEBOHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE CRILE BLDG. DESK AIII
Mailing Address - Street 2:CLEVELAND CLINIC
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:216-445-6626
Mailing Address - Fax:216-445-3797
Practice Address - Street 1:9500 EUCLID AVE CRILE BLDG. DESK AIII
Practice Address - Street 2:CLEVELAND CLINIC
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-445-6626
Practice Address - Fax:216-445-3797
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350472092080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0105434000Medicaid
KY64789407Medicaid
OH0478531Medicaid
WV0105434000Medicaid
A82843Medicare UPIN