Provider Demographics
NPI:1528110392
Name:KACHMARYK, MARTHA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:MARIA
Last Name:KACHMARYK
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 1:2004 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-3767
Mailing Address - Country:US
Mailing Address - Phone:773-772-8876
Mailing Address - Fax:773-252-8091
Practice Address - Street 1:2004 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3767
Practice Address - Country:US
Practice Address - Phone:773-772-8876
Practice Address - Fax:773-252-8091
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092803207W00000X
WV25081207W00000X
PAMD446985207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004932263OtherBCBS NUMBER
IL0004932263OtherBCBS NUMBER
G28404Medicare UPIN
IL0004932263OtherBCBS NUMBER
PA248079EVXMedicare PIN
WVWV2272AMedicare PIN