Healthcare Provider Details

I. General information

NPI: 1538967443
Provider Name (Legal Business Name): ANDREW PHILIP MATHEWS BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E SUPERIOR ST
CHICAGO IL
60611-4494
US

IV. Provider business mailing address

4301 W MARKHAM ST
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-8194
  • Fax:
Mailing address:
  • Phone: 501-686-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: