Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036154764 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036154764 | IL |
NPI | 1295199073 |
---|---|
Provider Name | Dr. Matt Mathew |
First Address | Skokie, IL 60076-5006 |
Second Address | Skokie, IL 60076-5006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 15/07/2021 |