Individual
DR. MATTHEW R PITTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036138487
IL
208600000X
Surgery Physician
125.055834
IL
208600000X
Surgery Physician
35123279
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0104249
—
OK
01
—
206147
MEDICARE PTAN GROUP
IL
01
—
F400237729
MEDICARE PTAN INDIVIDUAL
IL
Enumeration date
07/14/2009
Last updated
09/17/2015
Update your record
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