Healthcare Provider Details

I. General information

NPI: 1336550623
Provider Name (Legal Business Name): DANIEL MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN STREET AREA F
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2830 VICTORY PARKWAY, PAYOR ENROLLMENT
CINCINNATI OH
45206
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8400
  • Fax: 513-475-8228
Mailing address:
  • Phone: 513-585-5507
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35137087
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: