Healthcare Provider Details

I. General information

NPI: 1063115913
Provider Name (Legal Business Name): TODD J HIXENBAUGH MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 W MARKET ST STE 201
LIMA OH
45801-5609
US

IV. Provider business mailing address

658 W MARKET ST STE 201
LIMA OH
45801-5609
US

V. Phone/Fax

Practice location:
  • Phone: 419-879-6528
  • Fax:
Mailing address:
  • Phone: 419-879-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TODD J HIXENBAUGH
Title or Position: OWNER
Credential: MD
Phone: 419-879-6528