Provider Demographics
NPI:1497252407
Name:MARTIN, ALEXA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:MARTIN
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 1:620 N. LASALLE DR.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:312-598-2248
Mailing Address - Fax:312-500-5948
Practice Address - Street 1:1210 S INDIANA AVE APT 4012
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2790
Practice Address - Country:US
Practice Address - Phone:312-598-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
IL036157794202D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine