Provider Demographics
NPI:1568788198
Name:KING, MATTHEW JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 W AUGUSTA BLVD APT 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5301
Mailing Address - Country:US
Mailing Address - Phone:815-441-2933
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1800
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2960
Practice Address - Country:US
Practice Address - Phone:312-573-3700
Practice Address - Fax:312-573-3705
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD472014207V00000X
WV33125207V00000X
FLME143505207V00000X
NY306838207V00000X
NJ25MA10960000207V00000X
VA0101255704207V00000X
MDD77555207V00000X
DEC1-0024011207V00000X
IL036131806207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology