Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 036-120043 | IL |
NPI | 1053438507 |
---|---|
Provider Name | Dr. Vinita Mathew |
First Address | Warrenville, IL 60555-3845 |
Second Address | Warrenville, IL 60555-3845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 01/04/2014 |