Provider Demographics
NPI:1427090588
Name:MARTENS, JOHANN NICOLAUS (MD)
Entity type:Individual
Prefix:DR
First Name:JOHANN
Middle Name:NICOLAUS
Last Name:MARTENS
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 1:9200 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3240
Mailing Address - Country:US
Mailing Address - Phone:305-412-8315
Mailing Address - Fax:
Practice Address - Street 1:9200 SUNSET DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3240
Practice Address - Country:US
Practice Address - Phone:305-412-8315
Practice Address - Fax:305-412-8936
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64341207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376936400Medicaid
FLME64341OtherFLORIDA MEDICAL LICENSE
FL376936400Medicaid
FLME64341OtherFLORIDA MEDICAL LICENSE