Provider Demographics
NPI:1023097706
Name:MARTINEZ, CARLOS O (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:O
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 1:4325 ROSLYN RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5805
Mailing Address - Country:US
Mailing Address - Phone:630-964-5856
Mailing Address - Fax:
Practice Address - Street 1:120 N OAK ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3829
Practice Address - Country:US
Practice Address - Phone:630-856-6782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79771207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35244OtherBCBS
FL35244YMedicare ID - Type Unspecified
FL35244ZMedicare ID - Type Unspecified
H14957Medicare UPIN
FL35244WMedicare ID - Type Unspecified
FL35244OtherBCBS
FL35244XMedicare ID - Type Unspecified