Provider Demographics
NPI:1245211259
Name:MARTINEZ, DAVID JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:13707 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3188
Mailing Address - Country:US
Mailing Address - Phone:815-337-1871
Mailing Address - Fax:815-338-6297
Practice Address - Street 1:3707 DOTY RD
Practice Address - Street 2:SUITE H
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7530
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:815-337-2898
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036064805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD88629Medicare UPIN
IL962341Medicare PIN
404610Medicare ID - Type Unspecified