Provider Demographics
NPI:1386671709
Name:MARTINEZ, ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1938
Mailing Address - Country:US
Mailing Address - Phone:847-446-0202
Mailing Address - Fax:847-446-0208
Practice Address - Street 1:516 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WENONA
Practice Address - State:IL
Practice Address - Zip Code:61377-7526
Practice Address - Country:US
Practice Address - Phone:815-853-4402
Practice Address - Fax:815-853-4200
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099168Medicaid
G98317Medicare UPIN
K19465Medicare PIN