Individual
BASIL S WALDBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8300 TYLER BLVD., MENTOR, OH 44060-4328
(440) 205-1529
(440) 205-1529
Mailing address
8300 TYLER BLVD., MENTOR, OH 44060-4328
(440) 205-1529
(440) 205-1529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AW3083893
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0390090
—
OH
Enumeration date
08/21/2006
Last updated
07/08/2007
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