Individual
ABIGAIL M MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 W COURT ST, KANKAKEE, IL 60901-3661
(815) 937-2100
Mailing address
1478 S PRAIRIE AVE UNIT A, CHICAGO, IL 60605-3345
(312) 945-3001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01054360A
IN
207P00000X
Emergency Medicine Physician
Primary
036-101855
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000223683
ANTHEM BCBS
IN
05
—
200334020
—
IN
01
—
90001082
BCBS
IL
01
—
930118932
MEDICARE RAILROAD
IN
01
—
IN0050268
TRICARE
IN
Enumeration date
01/24/2006
Last updated
11/14/2008
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