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Individual
FIDEL MATA
Active
Individual
FIDEL MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
085.002235
IL
363AM0700X
Medical Physician Assistant
Primary
085-002235
IL
Other
Enumeration date
10/24/2006
Last updated
09/29/2026
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