Provider Demographics
NPI:1386693703
Name:MARTINI, MUAWIA (MD)
Entity type:Individual
Prefix:DR
First Name:MUAWIA
Middle Name:
Last Name:MARTINI
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:PAVILION A SUITE 240
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-740-1900
Practice Address - Fax:815-725-2413
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088791207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL039088791Medicaid
IL039088791Medicaid
ILL93752Medicare PIN
ID369591Medicare ID - Type UnspecifiedPROVIDER NUMBER
ILL93753Medicare PIN
ILH54944Medicare UPIN