Active NPI
Mary M Martino, D.P.M.
- Podiatrist
- Mundelein, IL
National Provider Identifier
1689734964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 016-004178
- Practice address
- 1324 Kettering Rd
Mundelein, IL 60060-5364 - Phone
- (847) 226-0267
- NPI assigned
- Dec 9, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 016-004178 | IL | Primary |
Addresses
Primary practice location
1324 Kettering Rd
Mundelein, IL 60060-5364
Mailing address
1324 Kettering Rd
Mundelein, IL 60060-5364
Phone (847) 226-0267
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 600-01724 | Other | IL | BCBS OF ILLINOIS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016-004178 | IL | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492992000000",
"number": "1689734964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1324 KETTERING RD",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600605364",
"telephone_number": "847-226-0267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1324 KETTERING RD",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600605364",
"telephone_number": "847-226-0267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINO",
"first_name": "MARY",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.P.M.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-09",
"last_updated": "2017-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IL",
"license": "016-004178",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF ILLINOIS",
"identifier": "600-01724",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mundelein, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.