Individual
GARY LYNN MARTZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3071 CHAMINADE CT SW, GRANDVILLE, MI 49418-2593
(616) 530-2177
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 530-2177
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301044764
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4228261
—
MI
05
—
4228280
—
MI
05
—
4283370
—
MI
05
—
4554956
—
MI
05
—
4592509
—
MI
Enumeration date
05/24/2006
Last updated
12/20/2013
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