Provider Demographics
NPI:1619966058
Name:MARTIN, STEVEN C (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3545 WESTMORELAND DR
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-8756
Practice Address - Country:US
Practice Address - Phone:765-412-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101261638207Q00000X
MI4301104697207Q00000X
RIMD16478207Q00000X
IL036161665207Q00000X
ARE-11879207Q00000X
GA081939207Q00000X
CAC159538207Q00000X
IN01068276A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200989300Medicaid
IN000001074701OtherANTHEM PROVIDER NUMBER
INM400021146Medicare PIN
IN815500201Medicare PIN
IN200989300Medicaid