Healthcare Provider Details

I. General information

NPI: 1083290001
Provider Name (Legal Business Name): BENJAMIN HABERER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 MONTGOMERY RD STE 103
CINCINNATI OH
45236-6100
US

IV. Provider business mailing address

PO BOX 933400
CLEVELAND OH
44193-0038
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1911
  • Fax: 513-984-1912
Mailing address:
  • Phone: 513-984-1911
  • Fax: 513-984-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.004143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: