Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 036-125081 | IL |
NPI | 1033307921 |
---|---|
Provider Name | Dr. Matthew Clifford Oswald |
First Address | Chicago, IL 60611-3167 |
Second Address | Chicago, IL 60611-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2007 |
Last Update Date | 05/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036125081-1 | (05) | IL |
036125081-2 | (05) | IL |
P00883321 | RAILROAD MEDICARE (01) | IL |