Provider Demographics
NPI:1316193824
Name:MATOKA, DEREK JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JOHN
Last Name:MATOKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:BUILDING 54
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-6266
Mailing Address - Fax:708-216-6585
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:BUILDING 54
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-6266
Practice Address - Fax:708-216-6585
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-1215622088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology