Provider Demographics
NPI:1124034533
Name:MATTHEWS, JOAN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:GUMOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC 4028
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-2545
Mailing Address - Fax:773-702-2190
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 4028
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-2545
Practice Address - Fax:773-702-2190
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2268933Medicaid
OHMA4055201Medicare ID - Type Unspecified
E58001Medicare UPIN
OH2268933Medicaid