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General NPI Number Information
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NPI Number | 1881634228
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Entity Type | Individual
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Provider Name | MARTIN J REPETTO MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 1504 PATTON DR
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City | MAHOMET
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State | IL
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Zip | 61853-8144
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Country | US
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Telephone | 217-586-2633
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 N MELVIN ST
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City | GIBSON CITY
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State | IL
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Zip | 60936-1477
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Country | US
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Telephone | 217-784-2579
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME85073
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License Number State | FL
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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 | 036118864
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License Number State | IL
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