Healthcare Provider Details

I. General information

NPI: 1083674170
Provider Name (Legal Business Name): CHARLES FRANKLIN MARTIN I MD, FACEP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 W 144TH PL SUITE 304
ORLAND PARK IL
60462-2561
US

IV. Provider business mailing address

1901 BUTTERFIELD RD SUITE 220
DOWNERS GROVE IL
60515-7915
US

V. Phone/Fax

Practice location:
  • Phone: 708-873-3450
  • Fax: 708-873-2791
Mailing address:
  • Phone: 630-725-2700
  • Fax: 847-407-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036087693
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number036087693
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: