Provider Demographics
NPI:1346377199
Name:MARTINEZ, STEVEN LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEE
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2070
Mailing Address - Country:US
Mailing Address - Phone:618-751-2059
Mailing Address - Fax:
Practice Address - Street 1:3003 CIVIC CIRCLE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5259
Practice Address - Country:US
Practice Address - Phone:618-993-1400
Practice Address - Fax:618-993-1522
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant