Provider Demographics
NPI:1275599219
Name:MEADOWS, MATTHEW AARON (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:MEADOWS
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 1:5215 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE F803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7014
Mailing Address - Country:US
Mailing Address - Phone:773-878-7555
Mailing Address - Fax:773-878-8545
Practice Address - Street 1:5215 N CALIFORNIA AVE
Practice Address - Street 2:SUITE F803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7014
Practice Address - Country:US
Practice Address - Phone:773-878-7555
Practice Address - Fax:773-878-8545
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111831208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111831Medicaid
K20423Medicare PIN
5514060010Medicare NSC
214706020Medicare PIN
IL036111831Medicaid