Individual
KEYNA ANN MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1144 W PLYMOUTH ST, BREMEN, IN 46506-1842
(574) 546-5363
(574) 546-2575
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01065420A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200969910
—
IN
Enumeration date
07/10/2006
Last updated
04/28/2023
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