Provider Demographics
NPI:1083674170
Name:MARTIN, CHARLES FRANKLIN I (MD, FACEP)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANKLIN
Last Name:MARTIN
Suffix:I
Gender:M
Credentials:MD, FACEP
Other - Prefix:
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Mailing Address - Street 1:1901 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-7915
Mailing Address - Country:US
Mailing Address - Phone:630-725-2700
Mailing Address - Fax:847-407-2448
Practice Address - Street 1:9501 W 144TH PL
Practice Address - Street 2:SUITE 304
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2561
Practice Address - Country:US
Practice Address - Phone:708-873-3450
Practice Address - Fax:708-873-2791
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360876932086S0129X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0162230XOtherBX
IL0162230XOtherBX
F17568Medicare UPIN
ILK18517Medicare ID - Type Unspecified