Provider Demographics
NPI:1093094690
Name:MARTIJA, ALMA MIA ROSAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALMA MIA
Middle Name:ROSAL
Last Name:MARTIJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ALMA MIA
Other - Middle Name:MARTIJA
Other - Last Name:WULFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1301 COPPERFIELD AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2054
Mailing Address - Country:US
Mailing Address - Phone:815-726-2368
Mailing Address - Fax:815-774-4799
Practice Address - Street 1:1301 COPPERFIELD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2054
Practice Address - Country:US
Practice Address - Phone:815-726-2368
Practice Address - Fax:815-774-4799
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.103214208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-103214OtherDEPT OF FINANCIAL AND PROFESSIONAL REGULATION
ILFM2749452OtherDEA