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: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 MONTGOMERY RD STE 103
CINCINNATI OH
45236-6100
US

IV. Provider business mailing address

11821 MASON MONTGOMERY RD # 4B
CINCINNATI OH
45249-3705
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1911
  • Fax: 513-984-1912
Mailing address:
  • Phone: 513-489-2400
  • Fax: 513-489-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.004143
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.004143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: