MEDICARE: WILLIAM EARL MARTENS MD

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	207VG0400X	Gynecology Physician	14665020	WI

General Provider Information

NPI Number	:	1790741494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM EARL MARTENS MD

Provider Business Mailing Address
First Line	:	19475 W NORTH AVE
Second Line	:	SUITE 400
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4199
Country	:	US
Telephone Number	:	262-780-4000
Fax Number	:	262-780-4090

Provider Business Practice Location Address
First Line	:	19475 W NORTH AVE
Second Line	:	SUITE 400
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4199
Country	:	US
Telephone Number	:	262-780-4000
Fax Number	:	262-780-4090

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

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	07/08/2007

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