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General NPI Number Information
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NPI Number | 1366971152
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Entity Type | Individual
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Provider Name | MADHU MATHEW MD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 25 N WINFIELD RD STE 420
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City | WINFIELD
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State | IL
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Zip | 60190-1379
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Country | US
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Telephone | 630-682-8700
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Fax | 630-352-5582
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Provider Business Mailing Address
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Address Line | 1215 E MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912-1811
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Country | US
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Telephone | 517-364-3522
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Fax | 517-364-2763
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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 | 4301503970
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RT0003X
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Taxonomy Name | Transplant Hepatology Physician
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License Number | 306030
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number | 306030
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036161943
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License Number State | IL
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