Provider Demographics
NPI:1750560009
Name:MARTIN J. SZANTO, M.D., S.C.
Entity type:Organization
Organization Name:MARTIN J. SZANTO, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-331-7908
Mailing Address - Street 1:6374 N LINCOLN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1275
Mailing Address - Country:US
Mailing Address - Phone:773-539-4145
Mailing Address - Fax:773-539-1207
Practice Address - Street 1:6374 N LINCOLN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1275
Practice Address - Country:US
Practice Address - Phone:773-539-4145
Practice Address - Fax:773-539-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036039841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL466180OtherMEDICARE PROVIDER
IL0021608067OtherBLUE CROSS PROVIDER
IL111910408OtherRAILROAD MEDICARE
ILK46072OtherMEDICARE PTAN
IL036039841Medicaid
IL1629059902OtherINDIVIDUAL NPI
IL036039841Medicaid