Provider Demographics
NPI:1619070224
Name:WEST OHIO DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:WEST OHIO DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEAPHY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:419-229-6781
Mailing Address - Street 1:750 W HIGH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2967
Mailing Address - Country:US
Mailing Address - Phone:419-229-6781
Mailing Address - Fax:419-229-3490
Practice Address - Street 1:750 W HIGH ST STE 300
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2967
Practice Address - Country:US
Practice Address - Phone:419-229-6781
Practice Address - Fax:419-229-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040604207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340321Medicaid
HE0437053Medicare ID - Type Unspecified
A76281Medicare UPIN