MEDICARE: MISS MARISOL MARTINEZ

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	163WC0200X	Critical Care Medicine Registered Nurse	041463182	IL
2	367500000X	Certified Registered Nurse Anesthetist	209030336	IL

General Provider Information

NPI Number	:	1679292106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARISOL MARTINEZ

Provider Business Mailing Address
First Line	:	2500 W 46TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-1334
Country	:	US
Telephone Number	:	773-971-5192
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W 46TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-1334
Country	:	US
Telephone Number	:	773-971-5192
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	05/08/2025

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Directions to “ MISS MARISOL MARTINEZ ” Practice Location

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