Provider Demographics
NPI:1225311368
Name:MARTIN, ERIN KATHLEEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:KATHLEEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:KATHLEEN
Other - Last Name:MUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 E HURON ST
Mailing Address - Street 2:GALTER 11-140
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-926-8636
Mailing Address - Fax:
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-836-4220
Practice Address - Fax:219-836-4171
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99048750A363A00000X
NY23 015843363A00000X
IL085004212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant