Healthcare Provider Details

I. General information

NPI: 1699051268
Provider Name (Legal Business Name): MATHEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9327 N 3RD ST SUITE 200
PHOENIX AZ
85020-2473
US

IV. Provider business mailing address

PO BOX 11773
CHANDLER AZ
85248-0013
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-0595
  • Fax: 602-997-0594
Mailing address:
  • Phone: 480-907-7707
  • Fax: 480-907-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number32945
License Number StateAZ

VIII. Authorized Official

Name: DR. ANU K MATHEW
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 480-907-7707