Provider Demographics
NPI:1578568341
Name:MARTIN, PATRICIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 CHESTNUT ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3248
Mailing Address - Country:US
Mailing Address - Phone:630-325-9010
Mailing Address - Fax:630-325-9023
Practice Address - Street 1:333 CHESTNUT ST
Practice Address - Street 2:STE 101
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3248
Practice Address - Country:US
Practice Address - Phone:630-325-9010
Practice Address - Fax:630-325-9023
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036058925207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058925Medicaid
IL415240Medicare ID - Type Unspecified
IL742620Medicare ID - Type Unspecified