Provider Demographics
NPI:1083290001
Name:HABERER, BENJAMIN (DPM)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:HABERER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933400
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0038
Mailing Address - Country:US
Mailing Address - Phone:513-984-1911
Mailing Address - Fax:513-984-1912
Practice Address - Street 1:8280 MONTGOMERY RD STE 103
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6100
Practice Address - Country:US
Practice Address - Phone:513-984-1911
Practice Address - Fax:513-984-1912
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.004143213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist