Provider Demographics
NPI:1366837379
Name:MARTINEZ, DENNIS MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
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 1:195N HARBOR DR 3406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7533
Mailing Address - Country:US
Mailing Address - Phone:708-289-8095
Mailing Address - Fax:
Practice Address - Street 1:10604 SOUTHWEST HWY STE 107
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2717
Practice Address - Country:US
Practice Address - Phone:708-422-0636
Practice Address - Fax:708-371-9330
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146210207RC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine