MEDICARE: GUY W MATTANA D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016003633	IL

General Provider Information

NPI Number	:	1871599480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUY W MATTANA D.P.M.

Provider Business Mailing Address
First Line	:	150 N RIVER RD
Second Line	:	SUITE 220
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1272
Country	:	US
Telephone Number	:	847-487-2827
Fax Number	:	847-487-2860

Provider Business Practice Location Address
First Line	:	150 N RIVER RD
Second Line	:	STE 220
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1272
Country	:	US
Telephone Number	:	847-487-2827
Fax Number	:	847-487-2860

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	05/23/2013

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Directions to “ GUY W MATTANA D.P.M.” Practice Location

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