MEDICARE: DENNIS MICHAEL MARTINEZ D.O.

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
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036146210	IL
2	2085R0202X	Diagnostic Radiology Physician	036146210	IL
3	207RP1001X	Pulmonary Disease Physician	036146210	IL

General Provider Information

NPI Number	:	1366837379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS MICHAEL MARTINEZ D.O.

Provider Business Mailing Address
First Line	:	195N HARBOR DR 3406
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7533
Country	:	US
Telephone Number	:	708-289-8095
Fax Number	:

Provider Business Practice Location Address
First Line	:	10604 SOUTHWEST HWY STE 107
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2717
Country	:	US
Telephone Number	:	708-422-0636
Fax Number	:	708-371-9330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	04/10/2026

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