Individual
DEMETRIA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 S EXECUTIVE DR, SUITE 101, BROOKFIELD, WI 53005-4216
(888) 964-6681
(888) 662-0859
Mailing address
888 WORCESTER ST, SUITE 130, WELLESLEY, MA 02482-3717
(617) 964-6681
(339) 686-2561
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1027-25
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114157955
—
WI
Enumeration date
07/14/2009
Last updated
04/29/2016
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