Healthcare Provider Details

I. General information

NPI: 1609796663
Provider Name (Legal Business Name): EDITH CHRISTINA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

6447 S KEDVALE AVE
CHICAGO IL
60629-5108
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6028
  • Fax: 312-942-6863
Mailing address:
  • Phone: 312-942-6028
  • Fax: 312-942-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number041330468
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: