Provider Demographics
NPI:1114928355
Name:MAHER, MICHAEL ROBERT (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:MAHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W RUSS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-2457
Mailing Address - Country:US
Mailing Address - Phone:937-548-1244
Mailing Address - Fax:937-548-8898
Practice Address - Street 1:415 W RUSS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2457
Practice Address - Country:US
Practice Address - Phone:937-548-1244
Practice Address - Fax:937-548-8898
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3109M213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2197304Medicaid
OH2197304Medicaid
OH0589470002Medicare NSC
OHU79955Medicare UPIN