Provider Demographics
NPI:1174655633
Name:MARTIN, MICHAEL FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2100 FOREST AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1422
Mailing Address - Country:US
Mailing Address - Phone:408-292-5337
Mailing Address - Fax:408-292-1943
Practice Address - Street 1:2100 FOREST AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1422
Practice Address - Country:US
Practice Address - Phone:408-292-5337
Practice Address - Fax:408-292-1943
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-26453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AM6044084OtherDEA
00G264530Medicare ID - Type Unspecified
AM6044084OtherDEA