MEDICARE: DR. MARTIN D LOUIE 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	A41284	CA
2	207P00000X	Emergency Medicine Physician	A41284	CA

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	:	1770519621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN D LOUIE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 501132
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92150-1132
Country	:	US
Telephone Number	:	949-855-2843
Fax Number	:

Provider Business Practice Location Address
First Line	:	22941 TRITON WAY
Second Line	:	SUITE 148
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1238
Country	:	US
Telephone Number	:	949-855-2843
Fax Number	:	949-581-9686

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	12/06/2021

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