Healthcare Provider Details

I. General information

NPI: 1932880077
Provider Name (Legal Business Name): MATTHEW MICHAEL BIRCHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E ASH AVE
DECATUR IL
62526-6117
US

IV. Provider business mailing address

215 RED COACH DR
MISHAWAKA IN
46545-8307
US

V. Phone/Fax

Practice location:
  • Phone: 707-305-1118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: