Healthcare Provider Details

I. General information

NPI: 1033307863
Provider Name (Legal Business Name): RICARDO MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W LAKE ST STE 200
ADDISON IL
60101-2500
US

IV. Provider business mailing address

4201 WINFIELD RD FL 4
WARRENVILLE IL
60555-4025
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9001
  • Fax: 331-221-3971
Mailing address:
  • Phone: 331-221-6377
  • Fax: 331-221-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036087720
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier08143606
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE RR
# 2
Identifier036087720
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: