Healthcare Provider Details

I. General information

NPI: 1689749178
Provider Name (Legal Business Name): NEIL J MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10706 E US HIGHWAY 36
AVON IN
46123-7982
US

IV. Provider business mailing address

10706 E US HIGHWAY 36
AVON IN
46123-7982
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-3600
  • Fax: 317-271-3604
Mailing address:
  • Phone: 317-271-3600
  • Fax: 317-271-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01043286A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01042386A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01043286A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: