Healthcare Provider Details

I. General information

NPI: 1316273469
Provider Name (Legal Business Name): CHRISTINA MARTIN SAMS AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA MICHELLE MARTIN AA

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 W HIGGINS RD STE 110
ROSEMONT IL
60018-4906
US

IV. Provider business mailing address

PO BOX 443
BEDFORD PARK IL
60499-0443
US

V. Phone/Fax

Practice location:
  • Phone: 773-355-5300
  • Fax:
Mailing address:
  • Phone: 352-265-0077
  • Fax: 352-265-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number75000027A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA45
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: