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General NPI Number Information
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NPI Number | 1649270224
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Entity Type | Individual
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Provider Name | MATHEW W MACCUMBER MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 71 W 156TH ST STE 400
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City | HARVEY
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State | IL
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Zip | 60426-4265
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Country | US
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Telephone | 708-596-8710
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Fax | 708-596-9820
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Provider Business Mailing Address
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Address Line | 11516 183RD PL STE SW
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City | ORLAND PARK
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State | IL
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Zip | 60467-9471
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Country | US
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Telephone | 708-877-1300
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Fax | 708-596-8719
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036093409
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 036093409
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License Number State | IL
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