Healthcare Provider Details

I. General information

NPI: 1669534780
Provider Name (Legal Business Name): CHRISTOPHER LEE MARTING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/07/2022
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W WOOSTER ST
BOWLING GREEN OH
43402-2699
US

IV. Provider business mailing address

615 RIDGE POINT DR
DUNDEE MI
48131-8631
US

V. Phone/Fax

Practice location:
  • Phone: 419-354-8900
  • Fax:
Mailing address:
  • Phone: 734-529-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.010114
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101015484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: