Provider Demographics
NPI:1487859161
Name:MATHEW, GEORGE K (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:K
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE-230
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5200
Mailing Address - Country:US
Mailing Address - Phone:440-835-6263
Mailing Address - Fax:440-892-6632
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE-230
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5200
Practice Address - Country:US
Practice Address - Phone:440-835-6263
Practice Address - Fax:440-892-6632
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-044841208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0429334Medicaid
OHCO1828Medicare UPIN
OH0429334Medicaid