Basic Information
| Provider Information | |||||||||
| NPI: | 1932151651 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAPNICK | ||||||||
| FirstName: | REBEKAH | ||||||||
| MiddleName: | MAXINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24701 EUCLID AVE | ||||||||
| Address2: | THIRD FLOOR BILLING SERVICES | ||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441171714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163835303 | ||||||||
| FaxNumber: | 2163835309 | ||||||||
| Practice Location | |||||||||
| Address1: | 18599 LAKE SHORE BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441191093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163835303 | ||||||||
| FaxNumber: | 2163835309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 03/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-085050 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 26513668 | 05 | OH | MEDICAID |