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General NPI Number Information
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NPI Number | 1619149325
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Entity Type | Individual
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Provider Name | DEEPA MATHEW JOSEPH M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 1306 PLAINFIELD RD
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City | DARIEN
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State | IL
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Zip | 60561-2703
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Country | US
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Telephone | 630-810-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 6719 FIELDSTONE DR
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City | BURR RIDGE
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State | IL
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Zip | 60527-5262
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Country | US
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Telephone | 630-204-5867
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2005019827
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License Number State | MO
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