Healthcare Provider Details

I. General information

NPI: 1730195652
Provider Name (Legal Business Name): MARTINIQUE WOOD AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK RD SUITE 2000
ELMHURST IL
60126-5626
US

IV. Provider business mailing address

172 E SCHILLER ST
ELMHURST IL
60126-2816
US

V. Phone/Fax

Practice location:
  • Phone: 630-993-5676
  • Fax: 630-758-9940
Mailing address:
  • Phone: 630-993-5676
  • Fax: 630-758-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: