Provider Demographics
NPI:1942219639
Name:THORNTON, MARTHA F (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:F
Last Name:THORNTON
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 1:1007 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1317
Mailing Address - Country:US
Mailing Address - Phone:309-582-9440
Mailing Address - Fax:309-582-9449
Practice Address - Street 1:1007 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1317
Practice Address - Country:US
Practice Address - Phone:309-582-9440
Practice Address - Fax:309-582-9449
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016 004172213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE205OtherPODIATRY LIC NE
SD129OtherPODIATRY LIC. NUMBER
IL016-004172OtherPODIATRY LIC. IL
IL016-004172OtherPODIATRY LIC. IL
NEBT1305792OtherDEA NUMBER
NE091269Medicare ID - Type UnspecifiedMEDICARE PROVIDER