Provider Demographics
NPI:1013999572
Name:MARTIRE, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:MARTIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 W CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1402
Mailing Address - Country:US
Mailing Address - Phone:701-751-7750
Mailing Address - Fax:701-751-7734
Practice Address - Street 1:121 W CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1402
Practice Address - Country:US
Practice Address - Phone:701-751-7750
Practice Address - Fax:701-751-7734
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5911208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDMAR23893OtherBCBS OF ND
ND16458Medicaid
NDMAR23893OtherBCBS OF ND
NDC43030Medicare UPIN