Provider Demographics
NPI:1033136015
Name:WIZNITZER, MAX N (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:N
Last Name:WIZNITZER
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 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6295
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0430732084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000526174OtherANTHEM
PA0013055270003Medicaid
OH000000028264OtherANTHEM
OHP00445001OtherRAILROAD MEDICARE
OH0631598OtherBCMH
OH0631598Medicaid
OH731878OtherBUCKEYE
OH000000221332OtherUNISON
OH0640754OtherAETNA
MI1033136015Medicaid
OH364144OtherWELLCARE
OH0631598Medicaid
MI1033136015Medicaid
PA0013055270003Medicaid