Provider Demographics
NPI:1336115294
Name:MARTINEZ, HERIBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:HERIBERTO
Middle Name:
Last Name:MARTINEZ
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 1:5857 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4250
Mailing Address - Country:US
Mailing Address - Phone:708-780-1464
Mailing Address - Fax:708-780-1464
Practice Address - Street 1:5857 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4250
Practice Address - Country:US
Practice Address - Phone:708-780-1464
Practice Address - Fax:708-780-1464
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093980208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG45610Medicare UPIN
IL208892/K06104Medicare PIN