Healthcare Provider Details

I. General information

NPI: 1700290509
Provider Name (Legal Business Name): KELLY LYN MARTINKUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HIGHWAY A1A
INDIAN HARBOUR BEACH FL
32937-3340
US

IV. Provider business mailing address

500 N BREVARD AVE UNIT 320504
COCOA BEACH FL
32932-7022
US

V. Phone/Fax

Practice location:
  • Phone: 321-345-0199
  • Fax: 321-616-7656
Mailing address:
  • Phone: 321-345-0199
  • Fax: 321-616-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18779
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: