Provider Demographics
NPI:1639174121
Name:MARTIN, KURT R (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1550 E COUNTY LINE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0990
Mailing Address - Country:US
Mailing Address - Phone:317-497-6497
Mailing Address - Fax:317-497-6400
Practice Address - Street 1:1550 E COUNTY LINE RD
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0990
Practice Address - Country:US
Practice Address - Phone:317-497-6497
Practice Address - Fax:317-497-6400
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01053938A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200493980Medicaid
IN200493980Medicaid
IN215670BMedicare PIN