Healthcare Provider Details

I. General information

NPI: 1043019557
Provider Name (Legal Business Name): ARJUN MATHUR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

3230 EDEN AVE
CINCINNATI OH
45219-3303
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-5187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125.087892
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: