Healthcare Provider Details

I. General information

NPI: 1164836318
Provider Name (Legal Business Name): MICHELLE JANANIA MARTINEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W 17TH ST STE 101
SIOUX FALLS SD
57104-8805
US

IV. Provider business mailing address

15830 BALLANTYNE MEDICAL PL STE 200
CHARLOTTE NC
28277-0761
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8000
  • Fax: 605-328-8001
Mailing address:
  • Phone: 980-442-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number11765
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: