Provider Demographics
NPI:1861095713
Name:MARTIN, EMILY ELIZBAETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ELIZBAETH
Last Name:MARTIN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:676 N SAINT CLAIR ST STE 2140
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3143
Mailing Address - Country:US
Mailing Address - Phone:312-472-1234
Mailing Address - Fax:312-695-3644
Practice Address - Street 1:676 N SAINT CLAIR ST STE 2140
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3143
Practice Address - Country:US
Practice Address - Phone:312-472-1234
Practice Address - Fax:312-695-3644
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2023-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085008116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant