MEDICARE: MANUEL BURCIAGA MARTINEZ M.D.S.C.

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	261Q00000X	Clinic/Center		IL

General Provider Information

NPI Number	:	1679649503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANUEL BURCIAGA MARTINEZ M.D.S.C.

Provider Business Mailing Address
First Line	:	4006 W 26TH STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623
Country	:	US
Telephone Number	:	773-762-5050
Fax Number	:	773-762-2026

Provider Business Practice Location Address
First Line	:	4006 WEST 26TH STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623
Country	:	US
Telephone Number	:	773-762-5050
Fax Number	:	773-762-2026

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MANUEL MARTINEZ
Credential	:	MD
Telephone Number	:	773-762-5050

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	08/22/2020

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