Provider Demographics
NPI:1891742730
Name:WAXMAN, HOWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:WAXMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35000 CHARDON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9019
Mailing Address - Country:US
Mailing Address - Phone:440-571-5515
Mailing Address - Fax:440-571-5537
Practice Address - Street 1:35000 CHARDON RD
Practice Address - Street 2:STE 220
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9019
Practice Address - Country:US
Practice Address - Phone:440-571-5515
Practice Address - Fax:440-571-5537
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002098213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0511557Medicaid
OHWA0517265Medicare PIN
OH0511557Medicaid
OHT80534Medicare UPIN