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General NPI Number Information
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NPI Number | 1689036923
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Entity Type | Individual
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Provider Name | PHILLIP DOUGLAS MARTINEZ-KNOUSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 36500 AURORA DR
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City | SUMMIT
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State | WI
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Zip | 53066-4899
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Country | US
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Telephone | 262-434-8800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5031
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Country | US
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Telephone | 800-326-2250
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036.149823
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 22233-875
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License Number State | WI
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