MEDICARE: RICARDO MARTINEZ, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	036087720	IL
2	207Q00000X	Family Medicine Physician	036087720	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08143606	OTHER	IL	MEDICAR RR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124009360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICARDO MARTINEZ, MD, PC

Provider Business Mailing Address
First Line	:	1201 W ARMY TRAIL BLVD
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-3152
Country	:	US
Telephone Number	:	630-458-9200
Fax Number	:	630-458-8460

Provider Business Practice Location Address
First Line	:	1201 W ARMY TRAIL BLVD
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-3152
Country	:	US
Telephone Number	:	630-458-9200
Fax Number	:	630-458-8460

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICARDO MARTINEZ
Credential	:	M.D.
Telephone Number	:	630-458-9200

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	06/25/2014

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