1750560009 NPI number — MARTIN J. SZANTO, M.D., S.C.

Table of content: (NPI 1750560009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750560009 NPI number — MARTIN J. SZANTO, M.D., S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN J. SZANTO, M.D., S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750560009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6374 N LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60659-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-539-4145
Provider Business Mailing Address Fax Number:
773-539-1207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6374 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60659-1275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-539-4145
Provider Business Practice Location Address Fax Number:
773-539-1207
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF RCM
Authorized Official Telephone Number:
248-331-7908

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036039841 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 466180 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0021608067 . This is a "BLUE CROSS PROVIDER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 111910408 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: K46072 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036039841 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629059902 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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