MEDICARE: DR. BIJU T MATHEWS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	89508	FL
2	207RC0000X	Cardiovascular Disease Physician	ME89508	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386692804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIJU T MATHEWS MD

Provider Business Mailing Address
First Line	:	605 N WASHINGTON AVE
Second Line	:	SUITE 100
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2152
Country	:	US
Telephone Number	:	321-383-7600
Fax Number	:	321-383-8111

Provider Business Practice Location Address
First Line	:	605 N WASHINGTON AVE
Second Line	:	SUITE 100
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2152
Country	:	US
Telephone Number	:	321-383-7600
Fax Number	:	321-383-8111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/24/2013

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