Provider Demographics
NPI:1710474549
Name:MARTINEZ KING, LORENA CAROLINA (MD)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:CAROLINA
Last Name:MARTINEZ KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:CAROLINA
Other - Last Name:MARTINEZ GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19639
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9639
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:
Practice Address - Street 1:400 N 9TH ST FL 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5310
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-3952
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61271343207VM0101X, 207V00000X
IL036.175135207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679273OtherBASIC POSTGRADUATE TRAINING PERMIT
WA1710474549Medicaid