Healthcare Provider Details

I. General information

NPI: 1174054217
Provider Name (Legal Business Name): KARINE MATEVOSSIAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 10/30/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 PATRIOT BLVD SUITE 100
GLENVIEW IL
60026
US

IV. Provider business mailing address

2555 PATRIOT BLVD SUITE 200
GLENVIEW IL
60026
US

V. Phone/Fax

Practice location:
  • Phone: 847-998-8200
  • Fax: 847-998-6880
Mailing address:
  • Phone: 847-998-8200
  • Fax: 847-998-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.168978
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number036.168978
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: