Provider Demographics
NPI:1730118449
Name:MARTINEZ-AKSAMIT, SHANTI R (MD)
Entity Type:Individual
Prefix:
First Name:SHANTI
Middle Name:R
Last Name:MARTINEZ-AKSAMIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANTI
Other - Middle Name:R
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-2308
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:13101 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9554
Practice Address - Country:US
Practice Address - Phone:520-901-3559
Practice Address - Fax:520-901-3642
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25298207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102587Medicare PIN
G68242Medicare UPIN
Z76186Medicare PIN
Z82534Medicare PIN