Individual
HENRY MATTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
340 W LINCOLN ST, BELLEVILLE, IL 62220-1900
(618) 233-6044
(618) 233-3297
Mailing address
340 W LINCOLN ST, BELLEVILLE, IL 62220-1900
(618) 233-6044
(618) 233-3297
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036061332
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360613321
—
IL
01
—
060009692
RR MEDICARE
—
01
—
096884
HEALTH ALLIANCE
—
01
—
117064
HEALTHLINK
—
01
—
12475
ESSENCE
—
01
—
1413735
UHC
—
01
—
16272
BCBS MO
MO
01
—
237612
WELLCARE
—
01
—
2507183
SECURE HORIZONS
—
01
—
3709969003
GHP
—
01
—
42932
CMR
—
01
—
C41352
MERCY
—
Enumeration date
07/03/2006
Last updated
07/05/2012
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