Provider Demographics
NPI:1366671042
Name:MARTINEZ, LUIS MIGUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:MIGUEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N PINE ISLAND RD STE 302
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1849
Mailing Address - Country:US
Mailing Address - Phone:786-564-5847
Mailing Address - Fax:954-581-8382
Practice Address - Street 1:350 N PINE ISLAND RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1849
Practice Address - Country:US
Practice Address - Phone:954-581-8272
Practice Address - Fax:954-581-8382
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty