1780736470 NPI number — DR. MARTIN FINE M.D.

Table of content: DR. MARTIN FINE M.D. (NPI 1780736470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780736470 NPI number — DR. MARTIN FINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINE
Provider First Name:
MARTIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1780736470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 N MICHIGAN AVE
Provider Second Line Business Mailing Address:
SUITE 1010
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60601-7401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-236-0232
Provider Business Mailing Address Fax Number:
312-236-0233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 N MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 1010
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60601-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-236-0232
Provider Business Practice Location Address Fax Number:
312-236-0233
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , 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: 0021606173 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com