Individual
JAMES A MARTIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 N ADELAIDE ST, FENTON, MI 48430-2670
(810) 629-2245
(810) 629-6535
Mailing address
11398 OREGON CIR, FENTON, MI 48430-2496
(810) 629-7052
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301022219
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0255600
BLUE CROSS & BCN ID #
MI
01
—
0856001
HEALTHPLUS ID #
MI
01
—
1002568
MCLAREN HEALTH PLAN ID #
MI
05
—
1116870
—
MI
01
—
C2331
MCARE ID #
MI
Enumeration date
01/24/2006
Last updated
07/09/2007
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