Provider Demographics
NPI:1063981637
Name:MARTIN, ANTONIO (BA MED)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:BA MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 AUBURN DR STE 240
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4314
Mailing Address - Country:US
Mailing Address - Phone:216-904-4859
Mailing Address - Fax:
Practice Address - Street 1:21490 MILLER AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-2330
Practice Address - Country:US
Practice Address - Phone:216-904-4859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator