Organization
MARTINE NELSON, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTINE T NELSON MD (OWNER)
(630) 717-9600
Entity
Organization
Contact information
Practice address
2745 MAPLE AVE, SUITE 2A, LISLE, IL 60532-3280
(630) 717-9600
Mailing address
2745 MAPLE AVE, SUITE 2A, LISLE, IL 60532-3280
(630) 717-9600
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067467
—
IL
05
—
036108202
—
IL
Enumeration date
11/28/2007
Last updated
09/23/2008
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