Provider Demographics
NPI:1629059902
Name:SZANTO, MARTIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:SZANTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6374 N LINCOLN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1275
Mailing Address - Country:US
Mailing Address - Phone:773-539-4145
Mailing Address - Fax:773-539-1207
Practice Address - Street 1:6374 N LINCOLN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1275
Practice Address - Country:US
Practice Address - Phone:773-539-4145
Practice Address - Fax:773-539-1207
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-39841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
111910408OtherMEDICARE RAILROAD RET
IL1750560009OtherGROUP NPI
IL2160806731OtherBLUE CROSS
ILK46072OtherMEDICARE PTAN
IL036039841Medicaid
IL1750560009OtherGROUP NPI
IL036039841Medicaid