Provider Demographics
NPI:1659407781
Name:NEAD, MARTIN BRUCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BRUCE
Last Name:NEAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 E ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2524
Mailing Address - Country:US
Mailing Address - Phone:217-345-7506
Mailing Address - Fax:217-345-7507
Practice Address - Street 1:1014 E ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2524
Practice Address - Country:US
Practice Address - Phone:217-345-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00182659OtherRAILROAD MEDICARE
IL60201211OtherBLUE CROSS BLUE SHIELD
ILT87167Medicare UPIN
IL911040Medicare ID - Type UnspecifiedMEDICARE