Provider Demographics
NPI:1760446850
Name:MARTIN, MICHELE DAWN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DAWN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1845
Mailing Address - Country:US
Mailing Address - Phone:530-226-7639
Mailing Address - Fax:
Practice Address - Street 1:351 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-226-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4786213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760446850Medicaid
TX480026955OtherRAILROAD GBA - RAILROAD MEDICARE
TX045823401Medicaid
TX88152GOtherBC/BS TX#
TXU67775Medicare UPIN
TX045823401Medicaid
TX87886JMedicare ID - Type Unspecified