Provider Demographics
NPI:1659690758
Name:CALDWELL, MARTINA TRINESE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:TRINESE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 E. MEDICAL CENTER DRIVE
Mailing Address - Street 2:B1-380 TC
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5305
Mailing Address - Country:US
Mailing Address - Phone:734-763-7919
Mailing Address - Fax:734-763-9298
Practice Address - Street 1:1500 E. MEDICAL CENTER DRIVE
Practice Address - Street 2:B1-380 TC
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5305
Practice Address - Country:US
Practice Address - Phone:734-763-7919
Practice Address - Fax:734-763-9298
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096683207P00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program