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General NPI Number Information
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NPI Number | 1639149636
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Entity Type | Individual
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Provider Name | ABIGAIL M MARTINEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 500 W COURT ST
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City | KANKAKEE
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State | IL
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Zip | 60901-3661
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Country | US
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Telephone | 815-937-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 1478 S PRAIRIE AVE UNIT A
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City | CHICAGO
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State | IL
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Zip | 60605-3345
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Country | US
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Telephone | 312-945-3001
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-101855
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01054360A
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License Number State | IN
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