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General NPI Number Information
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NPI Number | 1497544456
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Entity Type | Individual
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Provider Name | JOHN MARTIN
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Gender | Male
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 316 MOORES RIVER DR
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City | LANSING
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State | MI
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Zip | 48910-1434
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Country | US
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Telephone | 517-887-0226
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Fax | 517-887-8121
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Provider Business Mailing Address
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Address Line | 6165 INNKEEPERS CT APT 73
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City | EAST LANSING
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State | MI
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Zip | 48823-1641
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Country | US
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Telephone | 248-836-7571
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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