MEDICARE: DR. ESTELLA FAVIOLA 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	207Q00000X	Family Medicine Physician	036-117092	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-117092	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1326173618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESTELLA FAVIOLA MARTINEZ M.D.

Provider Business Mailing Address
First Line	:	3550 E 118TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-7314
Country	:	US
Telephone Number	:	773-646-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 E 118TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-7314
Country	:	US
Telephone Number	:	773-646-9800
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	10/04/2016

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