Provider Demographics
NPI:1639149636
Name:MARTINEZ, ABIGAIL M (MD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 S PRAIRIE AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3345
Mailing Address - Country:US
Mailing Address - Phone:312-945-3001
Mailing Address - Fax:
Practice Address - Street 1:500 W COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3661
Practice Address - Country:US
Practice Address - Phone:815-937-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101855207P00000X
IN01054360A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90001082OtherBCBS
IN000000223683OtherANTHEM BCBS
IN930118932OtherMEDICARE RAILROAD
IN200334020Medicaid
ININ0050268OtherTRICARE
ILP00301896Medicare PIN
IN930118932OtherMEDICARE RAILROAD
INH29318Medicare UPIN
IN200334020Medicaid
IN189880FMedicare ID - Type Unspecified