Provider Demographics
NPI:1548225212
Name:MATHEU, JOSEPH M (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:MATHEU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5669 W 95TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-424-8070
Mailing Address - Fax:708-423-3370
Practice Address - Street 1:5669 W 95TH STREET
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-424-8070
Practice Address - Fax:708-423-3370
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043488Medicaid
IL036043488Medicaid
ILP12590Medicare ID - Type Unspecified