Provider Demographics
NPI:1124009360
Name:RICARDO MARTINEZ, MD, PC
Entity Type:Organization
Organization Name:RICARDO MARTINEZ, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-458-9200
Mailing Address - Street 1:1201 W ARMY TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3152
Mailing Address - Country:US
Mailing Address - Phone:630-458-9200
Mailing Address - Fax:630-458-8460
Practice Address - Street 1:1201 W ARMY TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3152
Practice Address - Country:US
Practice Address - Phone:630-458-9200
Practice Address - Fax:630-458-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-05
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087720207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08143606OtherMEDICAR RR
IL036087720Medicaid
IL555470Medicare PIN
IL08143606OtherMEDICAR RR