Provider Demographics
NPI:1548267461
Name:FUJIMURA, MARTIN K (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:K
Last Name:FUJIMURA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9000 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 403 MAIN STREET FAMILY PRACTICE INC
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-836-5171
Mailing Address - Fax:937-832-0728
Practice Address - Street 1:9000 NORTH MAIN ST
Practice Address - Street 2:SUITE 403 MAIN STREET FAMILY PRACTICE INC
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-836-5171
Practice Address - Fax:937-832-0728
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-02-22
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Provider Licenses
StateLicense IDTaxonomies
OH35055024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120585OtherUHC
OH0668246Medicaid
OH4327103OtherAETNA
OH0193792OtherCIGNA
000000014144OtherANTHEM BCBS
OH0193792OtherCIGNA
OH0668246Medicaid