Healthcare Provider Details

I. General information

NPI: 1174475719
Provider Name (Legal Business Name): ATZEL ALBINO MARTINEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 W CERMAK RD
CICERO IL
60804-2129
US

IV. Provider business mailing address

5741 W CERMAK RD
CICERO IL
60804-2129
US

V. Phone/Fax

Practice location:
  • Phone: 708-222-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085012036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: