=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942950134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIPIN MATHEW DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2022
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5009 RIVERCHASE DR STE 500
-----------------------------------------------------
City | PHENIX CITY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36867-7490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-448-9505
-----------------------------------------------------
Fax | 334-448-9575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MCGAW NORTHWESTERN FAMILY MEDICINE 298 RANDALL ROAD
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-208-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 102561
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 125079265
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------