Individual
TINA M MATTERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5950 LINCOLN AVE, UNIT W, LISLE, IL 60532-3104
(630) 541-8930
(630) 541-8940
Mailing address
5950 LINCOLN AVE, UNIT W, LISLE, IL 60532-3104
(630) 541-8930
(630) 541-8940
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036099511
IL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036099511
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCBS
022-27624
IL
Enumeration date
04/13/2007
Last updated
09/29/2009
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