NPIMap

Organization Active NPI

Martine Nelson, MD, LLC

  • Pediatric Adolescent Medicine Physician
  • Lisle, IL
National Provider Identifier
1790967016
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
MARTINE NELSON, MD, LLC
Practice address
2745 Maple Ave
Suite 2a
Lisle, IL 60532-3280
Phone
(630) 717-9600
NPI assigned
Nov 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Martine T Nelson, MDNPI 1669561478
Title
Owner
Phone
(630) 717-9600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

2745 Maple Ave
Suite 2a
Lisle, IL 60532-3280

Mailing address

2745 Maple Ave
Suite 2a
Lisle, IL 60532-3280
Phone (630) 717-9600

Other identifiers 2

IdentifierTypeStateIssuer
036067467MedicaidIL
036108202MedicaidIL

National Provider Directory

National Provider Directory

Locations

2745 Maple Ave
Ste 200
Lisle, IL 60532

2745 Maple Ave
Lisle, IL 60532
Phone (630) 717-9600

2745 Maple Ave
Ste 2A
Lisle, IL 60532
Phone (630) 717-9600

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1790967016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2745 MAPLE AVE",
            "address_2": "SUITE 2A",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323280",
            "telephone_number": "630-717-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2745 MAPLE AVE",
            "address_2": "SUITE 2A",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323280",
            "telephone_number": "630-717-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTINE NELSON, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "MARTINE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-717-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067467",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036108202",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.