Provider Demographics
NPI:1164462941
Name:MATAR, BASSAM F (MD)
Entity Type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:F
Last Name:MATAR
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 1:2000 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-4216
Mailing Address - Country:US
Mailing Address - Phone:847-871-1800
Mailing Address - Fax:847-871-1811
Practice Address - Street 1:2000 GOLF RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008
Practice Address - Country:US
Practice Address - Phone:847-871-1800
Practice Address - Fax:847-871-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL03609552207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095552Medicaid
ILF4372Medicare PIN
IL5817580001Medicare NSC