Individual
MICHAEL J MARTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 CARSON AVE STE 102, LA JUNTA, CO 81050-2700
(719) 383-5970
(719) 383-5974
Mailing address
1200 CARSON AVE STE 102, LA JUNTA, CO 81050-2700
(719) 383-5970
(719) 383-5974
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR36536
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01365360
—
CO
01
—
80164496
RAILROAD MEDICARE
CO
01
—
MAM6084
BLUE CROSS
CO
Enumeration date
07/02/2006
Last updated
04/18/2008
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