Healthcare Provider Details

I. General information

NPI: 1083718423
Provider Name (Legal Business Name): AZMEY AWAD MATARIEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N RANDALL RD STE 201
ELGIN IL
60123
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-3168
  • Fax: 847-695-4289
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036110058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: