Provider Demographics
NPI:1134243371
Name:BOCKS, MARTIN LINDSEY (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:LINDSEY
Last Name:BOCKS
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 1:20800 HARVARD RD
Mailing Address - Street 2:2ND FLR
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3058
Practice Address - Fax:216-844-5478
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128854207RA0002X
MI43010760172080P0202X, 390200000X
OH35-1288542080P0202X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program