Provider Demographics
NPI:1871596619
Name:DEBENEDETTI, LAURA L (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:L
Last Name:DEBENEDETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3094
Mailing Address - Fax:419-842-3048
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3094
Practice Address - Fax:419-842-3048
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082827207RC0000X
OH35083068D207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00711904OtherRRMC
OH2466068Medicaid
OH4117711Medicare PIN
P00711904OtherRRMC
OH4117716Medicare PIN
OH4117717Medicare PIN
OH4117715Medicare PIN
OH00062397Medicare PIN
OH4117713Medicare PIN
OH4118993Medicare PIN
MIMI1635003Medicare PIN
OH4117714Medicare PIN
OH4118995Medicare PIN
OH4117718Medicare PIN
OH4118994Medicare PIN
OH2466068Medicaid
OH4117712Medicare PIN
MI23450019Medicare PIN
0N23450Medicare PIN