Provider Demographics
NPI:1457319337
Name:MARTINO, ANTHONY JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:MARTINO
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 1:2225 W NORTH AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1107
Mailing Address - Country:US
Mailing Address - Phone:708-345-8255
Mailing Address - Fax:708-345-0534
Practice Address - Street 1:2225 W NORTH AVE
Practice Address - Street 2:SUITE I
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1107
Practice Address - Country:US
Practice Address - Phone:708-345-8255
Practice Address - Fax:708-345-0534
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
202785622OtherPRIVATE HEALTHCARE SYSTEM
ILLINOIS 04-10369OtherUNITED HEALTHCARE
IL036110934Medicaid
7474721OtherAENTA INSURANCE
IL1635319OtherBLUE CROSS BLUE SHIELD
ILLINOIS 04-10369OtherUNITED HEALTHCARE