MEDICARE: DR. MICHAEL J MARTIN M.D.

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	207R00000X	Internal Medicine Physician	036-112004	IL
2	2084P0800X	Psychiatry Physician	036-112004	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2220936	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1962415513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J MARTIN M.D.

Provider Business Mailing Address
First Line	:	24600 W. 127TH ST
Second Line	:	STE B325
City	:	PLAINFIELD
State	:	IL
Zip	:	60585-9502
Country	:	US
Telephone Number	:	815-731-9100
Fax Number	:	815-731-9110

Provider Business Practice Location Address
First Line	:	24600 W. 127TH ST
Second Line	:	STE B325
City	:	PLAINFIELD
State	:	IL
Zip	:	60585-9502
Country	:	US
Telephone Number	:	815-731-9100
Fax Number	:	815-731-9110

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	11/23/2010

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