MEDICARE: MATSAM MEDICAL GROUP, INC.

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821105651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATSAM MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	1383 E HERNDON AVE
Second Line	:	SUITE 102
City	:	FRESNO
State	:	CA
Zip	:	93720-3302
Country	:	US
Telephone Number	:	559-449-8004
Fax Number	:	559-449-8037

Provider Business Practice Location Address
First Line	:	1383 E HERNDON AVE
Second Line	:	SUITE 102
City	:	FRESNO
State	:	CA
Zip	:	93720-3302
Country	:	US
Telephone Number	:	559-449-8004
Fax Number	:	559-449-8037

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOGINDER S MATHARU
Credential	:	M.D.
Telephone Number	:	559-449-8004

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/03/2010

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Directions to “MATSAM MEDICAL GROUP, INC. ” Practice Location

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