Provider Demographics
NPI:1194896878
Name:MARTINEZ, DANIEL B (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-261-1210
Mailing Address - Fax:630-261-1211
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-261-1210
Practice Address - Fax:630-261-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360957762084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364390963OtherTAX ID