MEDICARE: NEETHA GHEJJI 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	207Q00000X	Family Medicine Physician	125053797	IL

General Provider Information

NPI Number	:	1902094253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEETHA GHEJJI MARTENS MD

Provider Business Mailing Address
First Line	:	685 W SLIPPERY ROCK DR
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-2398
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 N DEARBORN ST STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4618
Country	:	US
Telephone Number	:	312-694-2127
Fax Number	:

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

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	11/02/2017

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