Healthcare Provider Details

I. General information

NPI: 1528417136
Provider Name (Legal Business Name): PAMELA MARTEYKUOR MARTEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA MARTEYKUOR MARTEY M.D.

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WEST POLK STREET RM 1134 ADMINISTRATION BUILDING
CHICAGO IL
60612
US

IV. Provider business mailing address

1969 W OGDEN AVE DEPARTMENT OF PEDIATRICS JOHN H STROGER JR HOSPITAL OF
CHICAGO IL
60612-3765
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-9717
  • Fax:
Mailing address:
  • Phone: 312-864-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125068867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: