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Individual

DENISE PINE-MATTAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
410 N 2ND ST, MARSHALL, IL 62441-1010
(217) 826-2361
(217) 826-2366
Mailing address
PO BOX 2505, INDIANAPOLIS, IN 46206-2505
(812) 238-7783
(812) 238-4506

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01060692A
IN
207Q00000X
Family Medicine Physician
Primary
036114511
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036114511
IL
05
200876850
IN
01
P00459732
RR MEDICARE
IL
01
P00459735
RR MEDICARE
IN
Enumeration date
06/12/2006
Last updated
10/18/2010
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