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General NPI Number Information
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NPI Number | 1659586279
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Entity Type | Organization
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Legal Business Name | CARL P MATTIODA MD AND CHAOMING CHEN MDSC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 104 W 6TH ST
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City | STREATOR
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State | IL
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Zip | 61364-2899
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Country | US
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Telephone | 815-673-4363
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Fax | 815-672-2524
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Provider Business Mailing Address
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Address Line | 104 W 6TH ST
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City | STREATOR
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State | IL
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Zip | 61364-2899
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Country | US
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Telephone | 815-673-4363
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Fax | 815-672-2524
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARL P MATTIODA
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Credential | MC
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Telephone | 815-673-4363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
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License Number |
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License Number State | IL
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