Provider Demographics
NPI:1386702777
Name:MARTIN, HOWARD CLYDE (MD PHD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:CLYDE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 W ARGYLE ST
Mailing Address - Street 2:ARGYLE MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-989-7661
Mailing Address - Fax:773-989-7633
Practice Address - Street 1:1060 W ARGYLE ST
Practice Address - Street 2:ARGYLE MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-989-7661
Practice Address - Fax:773-989-7633
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076603208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001607687OtherBCBS
IL0001607687OtherBCBS
C87572Medicare UPIN