Provider Demographics
NPI:1588613038
Name:MARTIN, MICHAEL P (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6025
Mailing Address - Country:US
Mailing Address - Phone:402-323-8400
Mailing Address - Fax:402-323-8405
Practice Address - Street 1:6820 S 32ND ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6025
Practice Address - Country:US
Practice Address - Phone:402-323-8400
Practice Address - Fax:402-323-8405
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03548OtherBCBS
NE1588613038OtherTRICARE
NE8002OtherMIDLANDS CHOICE
NE0100924OtherUHC
NE8002OtherMIDLANDS CHOICE
F31870Medicare UPIN