Healthcare Provider Details

I. General information

NPI: 1992817191
Provider Name (Legal Business Name): A. K. MATHEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4177 S ARCHER AVE
CHICAGO IL
60632-1849
US

IV. Provider business mailing address

PO BOX 3663
OAK BROOK IL
60522-3663
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-2222
  • Fax: 773-254-8444
Mailing address:
  • Phone: 773-254-2222
  • Fax: 773-254-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036050312
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: