Provider Demographics
NPI:1013941699
Name:MARTINEZ, KEYNA ANN (MD)
Entity Type:Individual
Prefix:
First Name:KEYNA
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-2129
Mailing Address - Fax:
Practice Address - Street 1:1144 W PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1842
Practice Address - Country:US
Practice Address - Phone:574-546-5363
Practice Address - Fax:574-546-2575
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065420A207Q00000X
IN11013105A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200969910Medicaid
INP01067792OtherRR MEDICARE
IN162520069OtherMEDICARE PTAN
IN200969910Medicaid
IN000000720192OtherBCBS BMG LAKEVILLE
IN162520069OtherMEDICARE PTAN
IN200969910Medicaid
INM400059707Medicare PIN
IN000000721565OtherBCBS MEDPOINT