Healthcare Provider Details

I. General information

NPI: 1407030596
Provider Name (Legal Business Name): RUTH MARTENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2007
Last Update Date: 12/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 GLADSTONE DR
WHEATON IL
60187-8123
US

IV. Provider business mailing address

1913 GLADSTONE DR
WHEATON IL
60187-8123
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-5595
  • Fax:
Mailing address:
  • Phone: 630-668-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: