Provider Demographics
NPI:1073516522
Name:MARTINEAU, PHILIPPE (MD)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:MARTINEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 NORTHLAKE BLVD
Mailing Address - Street 2:STE 116
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4647
Mailing Address - Country:US
Mailing Address - Phone:561-844-6005
Mailing Address - Fax:561-844-0056
Practice Address - Street 1:4595 NORTHLAKE BLVD
Practice Address - Street 2:STE 116
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4647
Practice Address - Country:US
Practice Address - Phone:561-844-6005
Practice Address - Fax:561-844-0056
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00743652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL217787OtherAMERIGROUP
FL254615900Medicaid
FL299940OtherMAGELLAN
FL193133OtherWELLCARE
FL1187OtherMENTAL HEALTH NETWORK
FL15-57913OtherUNITED BEHAVIORAL HEALTH
FL44718OtherBCBS OF FL
FL254615900Medicaid