MEDICARE: MICHAEL MARTINEZ, M.D., S.C.

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	WI

General Provider Information

NPI Number	:	1376806620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL MARTINEZ, M.D., S.C.

Provider Business Mailing Address
First Line	:	225 S EXECUTIVE DR
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4257
Country	:	US
Telephone Number	:	262-787-4050
Fax Number	:	262-782-6040

Provider Business Practice Location Address
First Line	:	3305 S 20TH ST STE 150
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4941
Country	:	US
Telephone Number	:	414-384-2100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL MARTINEZ
Credential	:	M.D.
Telephone Number	:	262-787-4050

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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