Provider Demographics
NPI:1235474222
Name:FIRST, MARTIN ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ROY
Last Name:FIRST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W WRIGHTWOOD AVE
Mailing Address - Street 2:UNIT 13
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1250
Mailing Address - Country:US
Mailing Address - Phone:773-665-7751
Mailing Address - Fax:
Practice Address - Street 1:1 ASTELLAS WAY
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6111
Practice Address - Country:US
Practice Address - Phone:224-205-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-47881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist