Doctor Name: | DR. MATTHEW D MARTIN |
NPI Number: | 1912169095 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 245 Cherry St Se Suite 302 Grand Rapids, MI - 495034607 |
Business Phone Number: | 6164594131 |
Business Fax Number: | 6164596030 |
Mailing Address: | 245 Cherry St Se, Suite 302 GRAND RAPIDS |
State: | MI |
Postal Code: | 495034607 |
Phone Number: | 6164594131 |
Fax Number: | 6164596030 |
NPI Enumeration Date: | 06/30/2008 |
NPI Last Update Date: | 08/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |