Healthcare Provider Details

I. General information

NPI: 1679570220
Provider Name (Legal Business Name): THOMAS LOUIS TAXMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29001 CEDAR RD STE 500
LYNDHURST OH
44124-6501
US

IV. Provider business mailing address

29001 CEDAR RD STE 500
LYNDHURST OH
44124-6501
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-0500
  • Fax: 440-442-0501
Mailing address:
  • Phone: 440-442-0500
  • Fax: 440-442-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35050627T
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35050627
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number35050627
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.050627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: