Provider Demographics
NPI:1790206977
Name:MAERTIN, ALLEN RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:RICHARD
Last Name:MAERTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3516
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:6511 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7026
Practice Address - Country:US
Practice Address - Phone:260-425-2725
Practice Address - Fax:260-479-4604
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2020-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN11019647A207Q00000X
IN02005469A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine