MEDICARE: DR. MICHAEL MARTINEZ M.D.

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	207L00000X	Anesthesiology Physician	24574-020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295714707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL MARTINEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 599
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53141-0599
Country	:	US
Telephone Number	:	800-883-7243
Fax Number	:	714-647-1245

Provider Business Practice Location Address
First Line	:	3801 SPRING ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-1667
Country	:	US
Telephone Number	:	262-687-4011
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	12/23/2007

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