Healthcare Provider Details

I. General information

NPI: 1316038813
Provider Name (Legal Business Name): ALAN HOWARD MATSON M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 N AIRLITE ST
ELGIN IL
60123-4912
US

IV. Provider business mailing address

1121 LAKE COOK RD STE M
DEERFIELD IL
60015-5234
US

V. Phone/Fax

Practice location:
  • Phone: 847-931-5694
  • Fax:
Mailing address:
  • Phone: 847-945-4550
  • Fax: 847-948-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01067590A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-095385
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: