Provider Demographics
NPI:1962482133
Name:MARTINKO, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:MARTINKO
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6100 MINTON RD NW STE 202
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907
Practice Address - Country:US
Practice Address - Phone:321-308-0601
Practice Address - Fax:321-308-0598
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL290862080A0000X
GA0301402080A0000X
FLME0113438208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA030140OtherSTATE MEDICAL LICENSE
AL51593425OtherBCBS - 1504 SPRINGHILL AVE
FL006458500Medicaid
NC2006-01605OtherNC MEDICAL BOARD
AL29086OtherMEDICAL LICENSE
AL29086OtherMEDICAL LICENSE
AL510I370024Medicare PIN