Provider Demographics
NPI:1902936156
Name:MARTIN, DENNY R (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNY
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-9385
Mailing Address - Fax:517-353-9421
Practice Address - Street 1:1200 E MICHIGAN AVE STE 145
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1897
Practice Address - Country:US
Practice Address - Phone:517-353-9385
Practice Address - Fax:517-353-9421
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-06-27
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Provider Licenses
StateLicense IDTaxonomies
MI5101016319207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114766493Medicaid
MIC36082131Medicare PIN