Individual
ANDREW MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 LEGACY PLZ W, LA PORTE, IN 46350-5296
(219) 379-3166
(219) 324-9730
Mailing address
2022 KELLE DR, CHESTERTON, IN 46304-8708
(219) 364-4004
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01085305A
IN
390200000X
Student in an Organized Health Care Education/Training Program
MD470087
PA
Other
Enumeration date
03/31/2015
Last updated
09/14/2021
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