Provider Demographics
NPI:1871620831
Name:MARTINUZZI, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MARTINUZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 NE 128TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-889-1890
Mailing Address - Fax:425-899-1898
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-889-1890
Practice Address - Fax:425-899-1898
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
011142OtherKAISER-COMMERCIAL NUMBER
CO53501578Medicaid
COG28638Medicare UPIN
011142OtherKAISER-COMMERCIAL NUMBER