Provider Demographics
NPI:1528232741
Name:HAVEMANN, JUSTIN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:W
Last Name:HAVEMANN
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 1:19111 DETROIT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1740
Mailing Address - Country:US
Mailing Address - Phone:440-356-9991
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:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350966982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3148052Medicaid