Healthcare Provider Details

I. General information

NPI: 1174766745
Provider Name (Legal Business Name): ANISHA S MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

71 W 156TH ST STE 110
HARVEY IL
60426-4267
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5000
  • Fax:
Mailing address:
  • Phone: 708-915-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036133215
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC209688
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036133215
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC209688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: