Provider Demographics
NPI:1124071592
Name:MARTINCIC, DANKO (MD)
Entity type:Individual
Prefix:DR
First Name:DANKO
Middle Name:
Last Name:MARTINCIC
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 1:3815 N SCHREIBER WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8362
Mailing Address - Country:US
Mailing Address - Phone:208-755-2804
Mailing Address - Fax:208-765-0277
Practice Address - Street 1:1641 E POLSTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-2668
Practice Address - Country:US
Practice Address - Phone:208-755-2804
Practice Address - Fax:208-765-0277
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMC-0445207RH0000X, 207RX0202X, 207RH0003X
WAMD00046391207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1124071592Medicaid
WA1002988Medicaid
0209895OtherLABOR & INDUSTRIES
P00326348OtherRAILROAD MEDICARE
KAU94OtherBLUE CROSS OF IDAHO
WA7698780OtherAETNA
ID807531000Medicaid
WA8454431Medicaid
G8860249Medicare PIN
WA7698780OtherAETNA