Provider Demographics
NPI:1427054519
Name:MARTINI, SUZANNE EGBERS (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:EGBERS
Last Name:MARTINI
Suffix:
Gender:F
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 400
Mailing Address - Street 2:
Mailing Address - City:SUNMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47041-0400
Mailing Address - Country:US
Mailing Address - Phone:812-623-4800
Mailing Address - Fax:812-623-4018
Practice Address - Street 1:122 NIEMAN STREET
Practice Address - Street 2:
Practice Address - City:SUNMAN
Practice Address - State:IN
Practice Address - Zip Code:47041
Practice Address - Country:US
Practice Address - Phone:812-623-4800
Practice Address - Fax:812-623-4018
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200038870Medicaid
IN200038870Medicaid
ING01734Medicare UPIN