Provider Demographics
NPI:1124344478
Name:MARTINS, DARRYL J (DPM)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:J
Last Name:MARTINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:DARRYL
Other - Middle Name:
Other - Last Name:MARTINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:100 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1598
Mailing Address - Country:US
Mailing Address - Phone:517-879-4241
Mailing Address - Fax:517-879-4240
Practice Address - Street 1:100 S COOPER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1598
Practice Address - Country:US
Practice Address - Phone:517-879-4241
Practice Address - Fax:517-879-4240
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002348213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist