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General NPI Number Information
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NPI Number | 1184087462
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Entity Type | Individual
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Provider Name | MATTHEW MARTINI M.D
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Gender | Male
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Dates
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Enumeration Date | 04/03/2016
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 9555 76TH ST STE 3880
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1984
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Country | US
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Telephone | 626-563-6502
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Fax |
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Provider Business Mailing Address
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Address Line | 6308 8TH AVE
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City | KENOSHA
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State | WI
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Zip | 53143-5031
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Country | US
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Telephone | 262-577-8522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 69201
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 69201
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License Number State | WI
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