Provider Demographics
NPI:1487651881
Name:DEBIEC, ROBERT (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DEBIEC
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 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:1265 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4004
Practice Address - Country:US
Practice Address - Phone:330-758-8808
Practice Address - Fax:330-758-4288
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2308-0213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6420020-000Medicaid
OH0626595Medicaid
PA01909707Medicaid
4087303Medicare ID - Type Unspecified
0588234Medicare ID - Type Unspecified
0865818Medicare ID - Type Unspecified
0588232Medicare ID - Type Unspecified
0588233Medicare ID - Type Unspecified
0588236Medicare ID - Type Unspecified
0588238Medicare ID - Type Unspecified
OH0626595Medicaid
0865813Medicare ID - Type Unspecified
4087301Medicare ID - Type Unspecified
4087302Medicare ID - Type Unspecified
0865812Medicare ID - Type Unspecified
0865817Medicare ID - Type Unspecified
WV6420020-000Medicaid
0865815Medicare ID - Type Unspecified
0865814Medicare ID - Type Unspecified