Individual
CAROL A MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
711 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9108
(715) 284-5361
(715) 284-1390
Mailing address
711 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9108
(715) 284-5361
(715) 284-1390
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35705
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32074500
—
WI
01
—
35705
WISCONSIN LICENSE NUMBER
WI
01
—
84D66MA
MINNESOTA BLUE CROSS
MN
Enumeration date
06/22/2006
Last updated
03/07/2023
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