Provider Demographics
NPI:1205877503
Name:RABB, WILLIE C JR (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:C
Last Name:RABB
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13944 EUCLID AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3832
Mailing Address - Country:US
Mailing Address - Phone:216-249-9500
Mailing Address - Fax:216-249-9543
Practice Address - Street 1:27378 W OVIATT RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2139
Practice Address - Country:US
Practice Address - Phone:440-871-4700
Practice Address - Fax:440-871-4702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003351R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2461438Medicaid
OHT92026Medicare UPIN
OH2461438Medicaid