Provider Demographics
NPI:1912920562
Name:DEBEUKELAER, MARTIN M (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:M
Last Name:DEBEUKELAER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43624-1120
Mailing Address - Country:US
Mailing Address - Phone:419-251-2673
Mailing Address - Fax:419-251-0916
Practice Address - Street 1:2222 CHERRY ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2673
Practice Address - Country:US
Practice Address - Phone:419-251-8030
Practice Address - Fax:419-251-7764
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH350454122080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0435087Medicaid
A79728Medicare UPIN