Provider Demographics
NPI:1447236518
Name:LUXENBERG, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:LUXENBERG
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 1:4665 DOUGLAS CIR NW STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:659 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2026
Practice Address - Country:US
Practice Address - Phone:330-602-0767
Practice Address - Fax:330-365-3831
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064090L207P00000X
OH35064090207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0903991Medicaid
OHP00774259OtherMEDICARE RAILROAD
OH000000162489OtherANTHEM
OHLU4265042Medicare PIN
OH0903991Medicaid
OHP00774259OtherMEDICARE RAILROAD
OH110156290Medicare PIN
OH000000162489OtherANTHEM