Individual
DENISE MARIE MARTINCIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8259 N OCTAVIA AVE, NILES, IL 60714-2624
(216) 331-9365
(216) 671-3991
Mailing address
8259 N OCTAVIA AVE # 3, NILES, IL 60714-2624
(216) 331-9365
(216) 671-3991
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
347B00000X
Bus
—
—
347C00000X
Private Vehicle
—
IL
347E00000X
Transportation Broker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9987
—
IL
Enumeration date
03/28/2019
Last updated
03/28/2019
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