Provider Demographics
NPI:1407030596
Name:MARTENS, RUTH (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MARTENS
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 1:1913 GLADSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8123
Mailing Address - Country:US
Mailing Address - Phone:630-668-5595
Mailing Address - Fax:
Practice Address - Street 1:1913 GLADSTONE DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8123
Practice Address - Country:US
Practice Address - Phone:630-668-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-25
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2083A0100X, 2083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine