MEDICARE: DEBORAH HOPE MATEK MD

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	2084P0800X	Psychiatry Physician	036-064591	IL
2	2084P0804X	Child & Adolescent Psychiatry Physician	036-064591	IL

General Provider Information

NPI Number	:	1871591776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH HOPE MATEK MD

Provider Business Mailing Address
First Line	:	1901 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3714
Country	:	US
Telephone Number	:	312-864-6309
Fax Number	:	312-864-9371

Provider Business Practice Location Address
First Line	:	736 11TH ST
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-2601
Country	:	US
Telephone Number	:	847-853-2534
Fax Number	:	312-864-9371

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/09/2012

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