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NPI Code Detail

MEDICARE: BOUCHRA S DOUMET MD

MEDICARE:   BOUCHRA S DOUMET  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35.083437OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00358429OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164407532
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOUCHRA S DOUMET MD
Provider Business Mailing Address
First Line : 5180 CHAPPEL DR STE B4&B5
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-7288
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5180 CHAPPEL DR STE B4&B5
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-7288
Country : US
Telephone Number : 567-585-0380
Fax Number : 567-585-0381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 03/16/2026

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Practice Location Address:
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Directions to “ BOUCHRA S DOUMET MD” Practice Location

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