Individual
JEROME MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 S WOOD ST, CHICAGO, IL 60612-4325
(815) 298-3950
Mailing address
900 S CLARK ST APT 1817, CHICAGO, IL 60605-3697
(815) 298-3950
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
125071031
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/03/2017
Last updated
05/17/2020
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