MEDICARE: MATHEW LLC

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
1	174400000X	Specialist	32945	AZ

General Provider Information

NPI Number	:	1699051268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATHEW LLC

Provider Business Mailing Address
First Line	:	PO BOX 11773
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-0013
Country	:	US
Telephone Number	:	480-907-7707
Fax Number	:	480-907-7097

Provider Business Practice Location Address
First Line	:	9327 N 3RD ST
Second Line	:	SUITE 200
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2473
Country	:	US
Telephone Number	:	602-997-0595
Fax Number	:	602-997-0594

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. ANU K MATHEW
Credential	:	M.D.
Telephone Number	:	480-907-7707

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/03/2012

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Directions to “MATHEW LLC ” Practice Location

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