Provider Demographics
NPI:1366492324
Name:TWADDLE, MARTHA L (MD, FACP, FAAHPM)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:L
Last Name:TWADDLE
Suffix:
Gender:F
Credentials:MD, FACP, FAAHPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25400 N SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-9460
Mailing Address - Country:US
Mailing Address - Phone:847-556-1697
Mailing Address - Fax:847-556-1505
Practice Address - Street 1:2050 CLAIRE COURT
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7635
Practice Address - Country:US
Practice Address - Phone:847-467-7423
Practice Address - Fax:847-556-1505
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074835207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-074835Medicaid
IL036-074835Medicaid
ILL64615Medicare ID - Type UnspecifiedCOOK COUNTY NUMBER
ILL94491Medicare ID - Type UnspecifiedLAKE COUNTY NUMBER