Basic Information
| Provider Information | |||||||||
| NPI: | 1487665337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAVER | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3428 HUNTERS XING | ||||||||
| Address2: | |||||||||
| City: | STOW | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442244746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306779385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6847 N CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | RAVENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442663929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302970811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 04/02/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 35-059923 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 00000027272 | 01 | OH | ANTHEM PROVIDER NUMBER | OTHER | 0957317 | 05 | OH | MEDICAID |