Provider Demographics
NPI:1629364500
Name:MARTINEZ, GABRIEL BK (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:BK
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 W CERMAK RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2972
Mailing Address - Country:US
Mailing Address - Phone:312-842-1229
Mailing Address - Fax:
Practice Address - Street 1:238 W CERMAK RD
Practice Address - Street 2:UNIT D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2972
Practice Address - Country:US
Practice Address - Phone:312-842-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist