Healthcare Provider Details

I. General information

NPI: 1396239679
Provider Name (Legal Business Name): MATTHEW URBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W HARRISON ST
CHICAGO IL
60612-3800
US

IV. Provider business mailing address

385 STATE ROUTE 24 STE 3K
CHESTER NJ
07930-2910
US

V. Phone/Fax

Practice location:
  • Phone: 443-926-4937
  • Fax:
Mailing address:
  • Phone: 908-879-2222
  • Fax: 283-205-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125072980
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA12016400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: