Provider Demographics
NPI:1215206370
Name:JUSTIN W HAVEMANN MD LLC
Entity Type:Organization
Organization Name:JUSTIN W HAVEMANN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAVEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-356-9991
Mailing Address - Street 1:180 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1621
Mailing Address - Country:US
Mailing Address - Phone:440-523-9111
Mailing Address - Fax:
Practice Address - Street 1:19111 DETROIT RD STE 103
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1740
Practice Address - Country:US
Practice Address - Phone:440-356-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350966982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty