Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 125055677 | IL |
Y | 111NI0900X | Internist | 125055677 | IL |
NPI | 1003184128 |
---|---|
Provider Name | Dr. Samreen Mattoo |
First Address | Aurora, IL 60502-6763 |
Second Address | Melrose Park, IL 60160-4039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2011 |
Last Update Date | 03/12/2011 |