Active NPI
Perry Myles Martin, M.D.
- Internal Medicine Physician
- Chicago, IL
National Provider Identifier
1962732586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 125053712
- Practice address
- 1900 W Polk St
Chicago, IL 60612-3723 - Phone
- (312) 864-7203
- NPI assigned
- Jan 4, 2010
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 125053712 | IL | Primary |
Addresses
Primary practice location
1900 W Polk St
Chicago, IL 60612-3723
Mailing address
2800 W North Ave
#304
Chicago, IL 60647-5120
Phone (773) 576-3240
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125053712 | IL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262563200000",
"number": "1962732586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 W NORTH AVE",
"address_2": "#304",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606475120",
"telephone_number": "773-576-3240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 W POLK ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123723",
"telephone_number": "312-864-7203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "PERRY",
"middle_name": "MYLES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-04",
"last_updated": "2010-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125053712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.