Provider Demographics
NPI:1154593572
Name:RUDY M. ROUWEYHA DPM LLC
Entity type:Organization
Organization Name:RUDY M. ROUWEYHA DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROUWEYHA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-534-4442
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000199044OtherANTHEMBCBS
OH5965490001Medicare NSC
RO0694362Medicare PIN