Provider Demographics
NPI:1194848234
Name:MARTINEZ-LU, KIANFA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIANFA
Middle Name:
Last Name:MARTINEZ-LU
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 1:13003 SW 42ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4005
Mailing Address - Country:US
Mailing Address - Phone:786-897-4420
Mailing Address - Fax:
Practice Address - Street 1:7100 W 20TH AVE STE 412
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1811
Practice Address - Country:US
Practice Address - Phone:954-322-1110
Practice Address - Fax:954-322-1099
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103812207L00000X, 207LP2900X
GA062556207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114843200Medicaid