Provider Demographics
NPI:1518602697
Name:MARTES, JOSUE (MD STUDENT)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:
Last Name:MARTES
Suffix:
Gender:M
Credentials:MD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9020032
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-0032
Mailing Address - Country:US
Mailing Address - Phone:787-721-2160
Mailing Address - Fax:
Practice Address - Street 1:1401 S CALIFORNIA AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1694
Practice Address - Country:US
Practice Address - Phone:787-235-6805
Practice Address - Fax:773-522-5855
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125086615390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program