Healthcare Provider Details

I. General information

NPI: 1447200357
Provider Name (Legal Business Name): RANJIV IGNATIUS MATHEWS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 8TH ST STE 3B
SPRINGFIELD IL
62701-1041
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-7123
  • Fax: 217-545-7305
Mailing address:
  • Phone: 217-545-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number036-136598
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: