Provider Demographics
NPI:1982710935
Name:MARTINEZ-TORRES, GUILLERMO G (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:G
Last Name:MARTINEZ-TORRES
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 1:2025 E. NEWPORT AVE
Mailing Address - Street 2:NORTH SHORE PATHOLOGISTS, SC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2906
Mailing Address - Country:US
Mailing Address - Phone:414-961-3976
Mailing Address - Fax:
Practice Address - Street 1:2025 E. NEWPORT AVE
Practice Address - Street 2:NORTH SHORE PATHOLOGISTS, SC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-961-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43166207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34254100Medicaid
F84354Medicare UPIN
WI34254100Medicaid