Provider Demographics
NPI:1437260502
Name:MARTIN, LAWRENCE O (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:O
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1430 NORTH ARLINGTON HEIGHTS RD
Mailing Address - Street 2:STE 214
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4825
Mailing Address - Country:US
Mailing Address - Phone:847-255-7773
Mailing Address - Fax:847-255-7803
Practice Address - Street 1:1430 NORTH ARLINGTON HEIGHTS RD
Practice Address - Street 2:STE 214
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4825
Practice Address - Country:US
Practice Address - Phone:847-255-7773
Practice Address - Fax:847-255-7803
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK45287Medicare PIN
D13570Medicare UPIN