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NPI Code Detail

MEDICARE: DR. ANDREW M LUXENBERG M.D.

MEDICARE: DR. ANDREW M LUXENBERG 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
1207P00000XEmergency Medicine Physician35064090LOH
2207L00000XAnesthesiology Physician35064090OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00774259OTHEROHMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000162489OTHEROHANTHEM

General Provider Information

NPI Number : 1447236518
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW M LUXENBERG M.D.
Provider Business Mailing Address
First Line : 4665 DOUGLAS CIR NW STE 100
Second Line :
City : CANTON
State : OH
Zip : 44718-3673
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 659 BOULEVARD ST
Second Line :
City : DOVER
State : OH
Zip : 44622-2026
Country : US
Telephone Number : 330-602-0767
Fax Number : 330-365-3831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 04/03/2019

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