Provider Demographics
NPI:1497805386
Name:HOWARD, MARTHA H (MD, PC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:H
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 N MARINE DR
Mailing Address - Street 2:SUITE200 - 1902
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1744
Mailing Address - Country:US
Mailing Address - Phone:773-935-6377
Mailing Address - Fax:773-929-4446
Practice Address - Street 1:4250 N MARINE DR
Practice Address - Street 2:SUITE200 - 1902
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1744
Practice Address - Country:US
Practice Address - Phone:773-935-6377
Practice Address - Fax:773-929-4446
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43048Medicare UPIN