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NPI Code Detail

MEDICARE: ALEXANDRA MATHERN M.D.

MEDICARE: ALEXANDRA MATHERN M.D.
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
1207V00000XObstetrics & Gynecology Physician036149401IL
2207VX0000XObstetrics Physician125.067768IL

General Provider Information

NPI Number : 1598149171
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA MATHERN M.D.
Provider Business Mailing Address
First Line : PO BOX 19248
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62794-9248
Country : US
Telephone Number : 217-528-7541
Fax Number :
Provider Business Practice Location Address
First Line : 2419 W CORNERSTONE CT
Second Line :
City : PEORIA
State : IL
Zip : 61614-2529
Country : US
Telephone Number : 217-528-7541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2015
Last Update Date : 04/07/2026

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