Provider Demographics
NPI:1124070164
Name:HAFTKOWYCZ, ERAST J (MD)
Entity type:Individual
Prefix:
First Name:ERAST
Middle Name:J
Last Name:HAFTKOWYCZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E RIVERVIEW AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9805
Mailing Address - Country:US
Mailing Address - Phone:419-599-0055
Mailing Address - Fax:419-599-0089
Practice Address - Street 1:1600 E RIVERVIEW AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9805
Practice Address - Country:US
Practice Address - Phone:419-599-0055
Practice Address - Fax:419-599-0089
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051731207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0831274Medicaid
OH0831274Medicaid
OH7314211Medicare PIN
OH0831274Medicaid
OHP00059613OtherRAILROAD CARE
E37098Medicare UPIN