Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 35045412 | OH |
NPI | 1912920562 |
---|---|
Provider Name | Martin M Debeukelaer |
First Address | Toledo, OH 43624-1120 |
Second Address | Toledo, OH 43608-2673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0435087 | (05) | OH |
A79728 | (02) |