Provider Demographics
NPI:1316034010
Name:ROSS, MATTHEW JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:ROSS
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 1:3S220 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2914
Mailing Address - Country:US
Mailing Address - Phone:630-393-2222
Mailing Address - Fax:630-393-2221
Practice Address - Street 1:3S220 WARREN AVE
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2914
Practice Address - Country:US
Practice Address - Phone:630-393-2222
Practice Address - Fax:630-393-2221
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072169207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
140004322OtherRR MEDICARE
IL036072169Medicaid
IL1578685368OtherCLINIC NPI
IL384010OtherMEDICARE GROUP #
140004322OtherRR MEDICARE
ILL50990Medicare ID - Type Unspecified