Individual
DR. KURT MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 351-4878
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-093490
IL
208000000X
Pediatrics Physician
Primary
036-093490
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027530
HAMP INSURANCE LNUMBER
IL
01
—
279844
HEALTHLINK INS NUMBER
IL
01
—
324139
GHP
IL
01
—
370012538
RR MEDICARE NUMBER
IL
01
—
3932056
BCBS OF IL
IL
01
—
49676
GHP INS. NUMBER
IL
01
—
7210895
AETNA
IL
Enumeration date
08/15/2006
Last updated
11/02/2020
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