MEDICARE: VICTOR M. 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	335E00000X	Prosthetic/Orthotic Supplier		IL

General Provider Information

NPI Number	:	1821269218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTOR M. MARTINEZ

Provider Business Mailing Address
First Line	:	3127 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2719
Country	:	US
Telephone Number	:	773-925-4184
Fax Number	:	773-925-4134

Provider Business Practice Location Address
First Line	:	3127 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2719
Country	:	US
Telephone Number	:	773-925-4184
Fax Number	:	773-925-4134

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VICTOR M MARTINEZ
Credential	:	CERTIFIED PEDORTHIST
Telephone Number	:	773-925-4184

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	03/13/2008

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Directions to “VICTOR M. MARTINEZ ” Practice Location

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