Individual
KENNETH J. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MT188409
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109461
TEMP LICENSE
MN
01
—
1669688057
NPI
MN
Enumeration date
05/15/2007
Last updated
03/07/2023
Update your record
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