Provider Demographics
NPI:1972592541
Name:MARTIN, JAMES R (MD)
Entity type:Individual
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First Name:JAMES
Middle Name:R
Last Name:MARTIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11900 E 12 MILE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3400
Mailing Address - Country:US
Mailing Address - Phone:586-576-4907
Mailing Address - Fax:576-576-4906
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-576-4907
Practice Address - Fax:576-576-4906
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2017-02-23
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Provider Licenses
StateLicense IDTaxonomies
MI063638208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
F81497Medicare UPIN