Individual
DR. MATTHEW JOSEPH MISCHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
(309) 624-8820
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
(309) 624-8820
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301081766
MI
208000000X
Pediatrics Physician
Primary
4301081766
MI
208M00000X
Hospitalist Physician
4301081766
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301081766
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121322
—
IL
01
—
809840
MEDICARE GROUP PTAN
IL
01
—
CA4079
RR MEDICARE GROUP PTAN
IL
01
—
P00617104
RR MEDICARE GROUP MEMBER PTAN
IL
Enumeration date
04/12/2007
Last updated
09/26/2008
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