Provider Demographics
NPI:1174604631
Name:DE MARTINI, TONY JOE (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:JOE
Last Name:DE MARTINI
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:PO BOX 19628
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9628
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-7877
Practice Address - Street 1:201 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5131
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-7877
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098403207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098403Medicaid
IL036098403Medicaid
ILI05469Medicare UPIN
ILK06007Medicare ID - Type Unspecified
ILK27034Medicare PIN