Provider Demographics
NPI:1629064803
Name:HABERKAMP, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HABERKAMP
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 1:9500 EUCLID AVE
Mailing Address - Street 2:DESK A71
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-6696
Mailing Address - Fax:216-445-9409
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DESK A71
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-6696
Practice Address - Fax:216-445-9409
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036072778207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00160607OtherRAILROAD MEDICARE
IL610797100OtherWORKERS COMPENSATION
OH3113553Medicaid
IL1627261OtherBCBS PROVIDER ID
IL1627261OtherBCBS PROVIDER ID
IL610797100OtherWORKERS COMPENSATION