Provider Demographics
NPI:1992718944
Name:MENKIN, MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:MENKIN
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 1:1802 KUHL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2004
Mailing Address - Country:US
Mailing Address - Phone:407-650-8075
Mailing Address - Fax:407-650-8275
Practice Address - Street 1:1802 KUHL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2004
Practice Address - Country:US
Practice Address - Phone:407-650-8075
Practice Address - Fax:407-650-8275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020838174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065047100Medicaid
FL065047100Medicaid
FLD63298Medicare UPIN