Provider Demographics
NPI:1932381886
Name:FRANCIS J. WAICKMAN, M.D. & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:FRANCIS J. WAICKMAN, M.D. & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WAICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-867-3767
Mailing Address - Street 1:544 WHITE POND DRIVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1141
Mailing Address - Country:US
Mailing Address - Phone:330-867-3767
Mailing Address - Fax:330-867-4857
Practice Address - Street 1:544 WHITE POND DR STE B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1141
Practice Address - Country:US
Practice Address - Phone:330-867-3767
Practice Address - Fax:330-867-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9856-W174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2197475Medicaid
OHB78258Medicare UPIN
OH2197475Medicaid