Provider Demographics
NPI:1699762567
Name:MARTINEZ, JESSE (DO)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:23900 ORCHARD LAKE RD
Mailing Address - Street 2:STE 150
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2500
Mailing Address - Country:US
Mailing Address - Phone:248-234-8690
Mailing Address - Fax:248-234-8690
Practice Address - Street 1:9377 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4622
Practice Address - Country:US
Practice Address - Phone:734-451-0070
Practice Address - Fax:734-451-1583
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4166042-11Medicaid
MI4387007-11Medicaid
MIH07688Medicare UPIN
MI4387007-11Medicaid