Provider Demographics
NPI:1962472969
Name:MARTINEZ, SERGE ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:ANTHONY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 NORTON HEALTHCARE BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2845
Mailing Address - Country:US
Mailing Address - Phone:502-425-5556
Mailing Address - Fax:502-992-0079
Practice Address - Street 1:4950 NORTON HEALTHCARE BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2845
Practice Address - Country:US
Practice Address - Phone:502-425-5556
Practice Address - Fax:502-992-0079
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21314207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64218143Medicaid
KY64218143Medicaid
C66350Medicare UPIN