Provider Demographics
NPI:1497703458
Name:HARRIS, MATTHEW NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:NATHAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:333 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3247
Mailing Address - Country:US
Mailing Address - Phone:630-325-6880
Mailing Address - Fax:630-325-5975
Practice Address - Street 1:333 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3247
Practice Address - Country:US
Practice Address - Phone:630-325-6880
Practice Address - Fax:630-325-5975
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108528207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497703458OtherRAIL ROAD MEDICARE
IL1497703458OtherNPI
IL0002215658OtherBCBSIL
IL1497703458OtherNPI
1497703458OtherRAIL ROAD MEDICARE
ILH91040Medicare UPIN