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General NPI Number Information
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NPI Number | 1104849330
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Entity Type | Organization
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Legal Business Name | ANTHONY MARTIN MDMS PC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 16001 W 9 MILE RD PROVIDENCE HOSPITAL
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 313-971-3698
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Fax |
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Provider Business Mailing Address
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Address Line | 10096 HART AVE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1126
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Country | US
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Telephone | 248-655-0337
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Fax | 248-655-0339
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ANTHONY MARTIN
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Credential | MD
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Telephone | 734-792-0441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301061359
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License Number State | MI
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