Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5911 | ND |
NPI | 1013999572 |
---|---|
Provider Name | Dr. Michael P Martire |
First Address | Bismarck, ND 58503-1402 |
Second Address | Bismarck, ND 58503-1402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16458 | (05) | ND |
C43030 | (02) | ND |
MAR23893 | BCBS OF ND (01) | ND |