Individual
DR. MATTHEW THOMAS MOYNIHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7232
(866) 600-2273
Mailing address
856 N FRANCISCO AVE UNIT 2, CHICAGO, IL 60622-4458
(630) 201-2607
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.154950
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.154950
ILLINOIS STATE MEDICAL LICENSE
IL
01
—
336.119004
ILLINOIS CONTROLLED SUBSTANCE LICENSE
IL
Enumeration date
03/21/2018
Last updated
07/25/2022
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