Healthcare Provider Details

I. General information

NPI: 1740245422
Provider Name (Legal Business Name): MATTHEW W SQUIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 OGDEN AVE
AURORA IL
60504-7597
US

IV. Provider business mailing address

1256 WATERFORD DR STE 230
AURORA IL
60504-4511
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-3800
  • Fax: 630-862-3085
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036159112
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: