MEDICARE: MR. ALEXIS MARTINEZ MSW

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	104100000X	Social Worker	6801019135	MI

General Provider Information

NPI Number	:	1124184254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXIS MARTINEZ MSW

Provider Business Mailing Address
First Line	:	2311 E STADIUM BLVD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4833
Country	:	US
Telephone Number	:	734-662-6300
Fax Number	:	734-662-3365

Provider Business Practice Location Address
First Line	:	2311 E STADIUM BLVD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4833
Country	:	US
Telephone Number	:	734-662-6300
Fax Number	:	734-662-3365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	07/08/2007

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