Provider Demographics
NPI:1316038813
Name:MATSON, ALAN HOWARD (M D)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:HOWARD
Last Name:MATSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 LAKE COOK RD STE M
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5234
Mailing Address - Country:US
Mailing Address - Phone:847-945-4550
Mailing Address - Fax:847-948-8103
Practice Address - Street 1:77 N AIRLITE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4912
Practice Address - Country:US
Practice Address - Phone:847-931-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067590A2085R0202X
IL036-0953852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095385OtherSTATE LICENSE #
IL036095385Medicaid
IN200971740AMedicaid
IN01067590AOtherSTATE LICENSE
IL1620188OtherBC/BS
IL1620188OtherBC/BS
INM400047800Medicare PIN
IL036095385Medicaid