Provider Demographics
NPI:1154322865
Name:MARTINEZ, SALUD MERENE (MD)
Entity Type:Individual
Prefix:DR
First Name:SALUD
Middle Name:MERENE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4309
Mailing Address - Country:US
Mailing Address - Phone:773-478-4411
Mailing Address - Fax:773-478-4473
Practice Address - Street 1:3701 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4309
Practice Address - Country:US
Practice Address - Phone:773-478-4411
Practice Address - Fax:773-478-4473
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-063356208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063356Medicaid
IL698500Medicare UPIN
IL036063356Medicaid