MEDICARE: STEPHANIE MARTINEZ PA-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	363A00000X	Physician Assistant	085.012086	IL

General Provider Information

NPI Number	:	1659949295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARTINEZ PA-C

Provider Business Mailing Address
First Line	:	1820 N TRIPP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4860
Country	:	US
Telephone Number	:	312-730-2894
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 N TRIPP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4860
Country	:	US
Telephone Number	:	312-730-2894
Fax Number	:

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

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	04/21/2026

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