Provider Information for 1801637020
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Miss DAPHNE JANICE MARTIN
Sex: Female
NPI: 1801637020
Last Updated: 2024-06-03
Certification Date: 2024-06-03
Certification Date: 2024-06-03
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1801637020 | ||||||||
| Enumeration Date | 2024-06-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2600 GOLF RD APT 202 GLENVIEW, IL 60025-4746 United States Phone: 773-226-6562 | Fax: | ||||||||
| Primary Practice Address | 4848 W IRVING PARK RD CHICAGO, IL 60641-2718 United States Phone: 773-347-9002 | Fax:773-866-8015 | ||||||||
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