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General NPI Number Information
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NPI Number | 1003124280
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Entity Type | Individual
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Provider Name | MELISSA A MARTINEZ MATEO M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2601 W MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1031
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Country | US
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Telephone | 618-549-5361
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Fax | 618-351-4878
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Provider Business Mailing Address
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Address Line | PO BOX 3988
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City | CARBONDALE
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State | IL
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Zip | 62902-3988
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Country | US
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Telephone | 618-457-5200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 01072250A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125056433
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036139158
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 11015804A
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License Number State | IN
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