Provider Demographics
NPI:1245586593
Name:MARKOS, MATHEW SHAJI (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:SHAJI
Last Name:MARKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2650 S CALIFORNIA AVE
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5146
Mailing Address - Country:US
Mailing Address - Phone:773-674-6123
Mailing Address - Fax:773-674-5113
Practice Address - Street 1:2650 S CALIFORNIA AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5146
Practice Address - Country:US
Practice Address - Phone:773-674-6123
Practice Address - Fax:773-674-5113
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.0713002084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry