MEDICARE: GABRIEL B.K. MARTINEZ LAC, LMT

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	171100000X	Acupuncturist	198.000948	IL

General Provider Information

NPI Number	:	1629364500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL B.K. MARTINEZ LAC, LMT

Provider Business Mailing Address
First Line	:	238 W CERMAK RD
Second Line	:	UNIT D
City	:	CHICAGO
State	:	IL
Zip	:	60616-2972
Country	:	US
Telephone Number	:	312-842-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 W CERMAK RD
Second Line	:	UNIT D
City	:	CHICAGO
State	:	IL
Zip	:	60616-2972
Country	:	US
Telephone Number	:	312-842-1229
Fax Number	:

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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