MEDICARE: DR. JOHN J HALUSCHAK MD

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	207RH0003X	Hematology & Oncology Physician	35057545	OH
2	207RX0202X	Medical Oncology Physician	35.057545	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000389964	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407895535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J HALUSCHAK MD

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD BLDG B
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3188
Fax Number	:	937-223-9811

Provider Business Practice Location Address
First Line	:	400 SUGAR CAMP CIR STE 200
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45409-1981
Country	:	US
Telephone Number	:	937-276-8320
Fax Number	:	937-276-8325

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/25/2022

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Directions to “ DR. JOHN J HALUSCHAK MD” Practice Location

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