Individual
HALEY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2320 E 93RD ST, CHICAGO, IL 60617-3909
(773) 967-5430
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006195RX
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/13/2019
Last updated
04/29/2022
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