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Individual

ANTHONY JOSEPH MARTINO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2225 W NORTH AVE, SUITE I, MELROSE PARK, IL 60160-1107
(708) 345-8255
(708) 345-0534
Mailing address
2225 W NORTH AVE, SUITE I, MELROSE PARK, IL 60160-1107
(708) 345-8255
(708) 345-0534

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036110934
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036110934
IL
01
1635319
BLUE CROSS BLUE SHIELD
IL
01
202785622
PRIVATE HEALTHCARE SYSTEM
01
7474721
AENTA INSURANCE
01
ILLINOIS 04-10369
UNITED HEALTHCARE
Enumeration date
05/02/2006
Last updated
03/04/2015
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