Provider Demographics
NPI:1083718423
Name:MATARIEH, AZMEY AWAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AZMEY
Middle Name:AWAD
Last Name:MATARIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N RANDALL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-695-3168
Mailing Address - Fax:847-695-4289
Practice Address - Street 1:1435 N RANDALL RD
Practice Address - Street 2:STE 201
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-695-3168
Practice Address - Fax:847-695-4289
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110058207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8262Medicare PIN