MEDICARE: DR. MICHAEL J. WAICKMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	35-05-9865-W	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386644631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J. WAICKMAN M.D.

Provider Business Mailing Address
First Line	:	544 WHITE POND DR
Second Line	:	SUITE B
City	:	AKRON
State	:	OH
Zip	:	44320-1141
Country	:	US
Telephone Number	:	330-867-3767
Fax Number	:	330-867-4857

Provider Business Practice Location Address
First Line	:	544 WHITE POND DR
Second Line	:	SUITE B
City	:	AKRON
State	:	OH
Zip	:	44320-1141
Country	:	US
Telephone Number	:	330-867-3767
Fax Number	:	330-867-4857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/09/2007

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