Healthcare Provider Details

I. General information

NPI: 1902487663
Provider Name (Legal Business Name): SARAH E MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E SUPERIOR ST STE 5-2149
CHICAGO IL
60611-2914
US

IV. Provider business mailing address

250 E SUPERIOR ST STE 5-2149
CHICAGO IL
60611-2914
US

V. Phone/Fax

Practice location:
  • Phone: 312-472-4685
  • Fax:
Mailing address:
  • Phone: 312-472-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036.178422
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: