MEDICARE: DR. ARPANA BROOR MATHUR MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036113594	IL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	553180	OTHER	IL	MEDICARE GROUP PTAN
3	834370	OTHER	IL	MEDICARE GROUP

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	336074258	OTHER	IL	IL STATE CTL SUBS LICENSE
4	036113594	OTHER	IL	IL STATE LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0-551-903-8	OTHER	IL	ECFMG NUMBER

NPI Number	:	1023090560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARPANA BROOR MATHUR MD

Provider Business Mailing Address
First Line	:	698 FEATHERSTONE RD
Second Line	:	SUITE 250
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6303
Country	:	US
Telephone Number	:	815-399-4404
Fax Number	:	815-484-7091

Provider Business Practice Location Address
First Line	:	698 FEATHERSTONE RD
Second Line	:	SUITE 250
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6303
Country	:	US
Telephone Number	:	815-399-4404
Fax Number	:	815-484-7091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	03/07/2023

698 FEATHERSTONE RD , SUITE 250
ROCKFORD, IL
61107-6303

Practice Phone: 815-399-4404
Practice Fax: 815-484-7091