MEDICARE: EMILY MARTIN

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	133V00000X	Registered Dietitian	164008488	IL

General Provider Information

NPI Number	:	1851102586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MARTIN

Provider Business Mailing Address
First Line	:	1520 W BELLE PLAINE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-7201
Country	:	US
Telephone Number	:	716-864-2058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 W BELLE PLAINE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-7201
Country	:	US
Telephone Number	:	716-864-2058
Fax Number	:

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

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	02/11/2026

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Directions to “ EMILY MARTIN ” Practice Location

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