Provider Demographics
NPI:1518382613
Name:BENAVIDES MARTINEZ, VICTOR H (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:H
Last Name:BENAVIDES MARTINEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:900 I ST FL 2
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5533
Practice Address - Country:US
Practice Address - Phone:219-324-1938
Practice Address - Fax:219-324-1602
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2023-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR29323207Q00000X
MI4301106900207Q00000X
IN01088414A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine