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NPI Code Detail

MEDICARE: ELIZABETH MURAYAMA CHAVEZ MATIAS DDS

MEDICARE: ELIZABETH MURAYAMA CHAVEZ MATIAS DDS
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry61494KS
21223G0001XGeneral Practice Dentistry1002424WI

General Provider Information

NPI Number : 1144748070
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH MURAYAMA CHAVEZ MATIAS DDS
Provider Business Mailing Address
First Line : 2050 E ALGONQUIN RD STE 610
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60173-4166
Country : US
Telephone Number : 888-988-4066
Fax Number : 847-496-4850
Provider Business Practice Location Address
First Line : 2280 W MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4707
Country : US
Telephone Number : 888-988-4066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2017
Last Update Date : 09/01/2020

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