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NPI Code Detail

MEDICARE: VIN MATHUR MD

MEDICARE: VIN MATHUR 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
1208600000XSurgery PhysicianT2006029715MO
22085N0700XNeuroradiology Physician036148391IL

General Provider Information

NPI Number : 1871694810
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIN MATHUR MD
Provider Business Mailing Address
First Line : 180 HARVESTER DR STE 110
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-4503
Country : US
Telephone Number : 773-702-1150
Fax Number :
Provider Business Practice Location Address
First Line : 5841 S. MARYLAND AVE
Second Line : MAIL CODE 2026
City : CHICAGO
State : IL
Zip : 60637-1443
Country : US
Telephone Number : 773-834-9980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 05/03/2019

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