Healthcare Provider Details

I. General information

NPI: 1003059288
Provider Name (Legal Business Name): DON MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

195 N HARBOR DR APT. 3406
CHICAGO IL
60601-7514
US

V. Phone/Fax

Practice location:
  • Phone: 773-926-8318
  • Fax:
Mailing address:
  • Phone: 312-898-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036134705
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number55083-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: