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Individual

AMY MARTYANOV

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
580 W COLLEGE AVE, MARQUETTE, MI 49855-2705
(906) 225-3993
Mailing address
2837 US 41 W, MARQUETTE, MI 49855-2252
(906) 225-3964
(906) 226-3875

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2006018424
MO
2084N0400X
Neurology Physician
LT19894
ND
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
4301099870
MI
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
51192
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
ENROLLED
MN
Enumeration date
04/01/2008
Last updated
07/07/2023
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