Individual
DR. PAUL J MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 338-6399
(317) 338-6359
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01087513A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300015843
—
IN
01
—
959090195
MEDICARE PTAN
IN
Enumeration date
04/09/2018
Last updated
09/15/2023
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