Healthcare Provider Details

I. General information

NPI: 1780178723
Provider Name (Legal Business Name): EMMA MARTZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 N ELM ST
HENDERSON KY
42420-2768
US

IV. Provider business mailing address

1413 N ELM ST STE 201
HENDERSON KY
42420-2767
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-8662
  • Fax: 270-826-8220
Mailing address:
  • Phone: 270-827-8662
  • Fax: 270-826-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11020171A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: