Provider Demographics
NPI:1912904467
Name:MARTINEK, ANN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:MARTINEK
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 1:89 SYLVANIA DR
Mailing Address - Street 2:2ND FL
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3237
Mailing Address - Country:US
Mailing Address - Phone:937-427-8900
Mailing Address - Fax:937-427-1710
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:2ND FL
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3237
Practice Address - Country:US
Practice Address - Phone:937-427-8900
Practice Address - Fax:937-427-1710
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057520207W00000X, 207WX0107X
OH35069885207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0284839Medicaid
OHMA0799731Medicare PIN
0801093OtherUNITED HEALTHCARE
OH0284839Medicaid
5151167OtherAETNA
D69885OtherHUMANA
0802271OtherEVERCARE
314074OtherAMERIGROUP
G25654Medicare UPIN
180026648Medicare PIN
OHMA0799731Medicare PIN
000000011450OtherBC/BS