Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 036087693 | IL |
NPI | 1083674170 |
---|---|
Provider Name | Dr. Charles Franklin Martin I |
First Address | Downers Grove, IL 60515-7915 |
Second Address | Orland Park, IL 60462-2561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0162230X | BX (01) | IL |
F17568 | (02) |