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General NPI Number Information
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NPI Number | 1215030366
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Entity Type | Individual
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Provider Name | DIANNE MARTIN MD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 5670 CAITO DR SUITE #125 BUILDING # 5
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City | INDPLS
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State | IN
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Zip | 46226-1364
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Country | US
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Telephone | 317-541-9159
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Fax | 317-541-9179
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Provider Business Mailing Address
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Address Line | 5670 CAITO DR SUITE #125 BUILDING # 5
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City | INDPLS
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State | IN
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Zip | 46226-1364
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Country | US
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Telephone | 317-541-9159
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Fax | 317-541-9179
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01029502
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01029502A
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License Number State | IN
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