Individual
MATHEW C MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
215 E. 1ST STREET, SUITE #212, KSB MEDICAL GROUP, DIXON, IL 61021
(815) 285-5484
(815) 285-5486
Mailing address
215 E. 1ST STREET, SUITE #212, KSB MEDICAL GROUP, DIXON, IL 61021
(815) 285-5484
(815) 285-5486
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
036-056556
IL
208800000X
Urology Physician
Primary
036.056556
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036056556
—
IL
Enumeration date
09/08/2006
Last updated
07/18/2011
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