Provider Demographics
NPI:1043571037
Name:RENNELS, MATTHEW L (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:RENNELS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 N REYNOLDS RD STE 170
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2076
Mailing Address - Country:US
Mailing Address - Phone:419-578-7590
Mailing Address - Fax:419-537-5605
Practice Address - Street 1:2865 N REYNOLDS RD STE 170
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2076
Practice Address - Country:US
Practice Address - Phone:419-578-7590
Practice Address - Fax:419-537-5605
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-011259207Q00000X
OH34.011259207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine