Provider Demographics
NPI:1003072463
Name:MARTIN, ALISSA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4201 ST. ANTIONE UHC 5D
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MI
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5515
Practice Address - Fax:313-745-5237
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2013-09-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301104197208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics