Provider Demographics
NPI:1669851812
Name:HALDEMAN, MICHELLE HISAKO (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HISAKO
Last Name:HALDEMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3748
Mailing Address - Country:US
Mailing Address - Phone:216-227-2194
Mailing Address - Fax:216-227-2196
Practice Address - Street 1:15800 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3748
Practice Address - Country:US
Practice Address - Phone:162-227-2194
Practice Address - Fax:216-227-2196
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003863213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0280427Medicaid