Provider Demographics
NPI:1174546113
Name:NIKLINSKI, WALDEMAR T (MD)
Entity type:Individual
Prefix:
First Name:WALDEMAR
Middle Name:T
Last Name:NIKLINSKI
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 1:2600 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2102
Mailing Address - Country:US
Mailing Address - Phone:513-618-2848
Mailing Address - Fax:513-618-2849
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:DEPT. OF PATHOLOGY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0001
Practice Address - Country:US
Practice Address - Phone:513-558-4500
Practice Address - Fax:513-558-2289
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-7085207ZP0102X
IL036-112134207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000381313OtherANTHEM
OH7746795OtherAETNA
IN200239880Medicaid
KY64112733Medicaid
OH2617716Medicaid
OH2617716Medicaid