Provider Demographics
NPI:1548423080
Name:MATHEW, BOBAN (MD)
Entity Type:Individual
Prefix:
First Name:BOBAN
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N 10TH ST
Mailing Address - Street 2:HEART & LUNG UNIT, ST ALEXIUS HOSPITAL
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4516
Mailing Address - Country:US
Mailing Address - Phone:701-530-7500
Mailing Address - Fax:
Practice Address - Street 1:310 N 10TH ST
Practice Address - Street 2:HEART & LUNG UNIT, ST ALEXIUS HOSPITAL
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4516
Practice Address - Country:US
Practice Address - Phone:701-530-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11354207RC0000X, 207RI0011X
WI71911207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease