Provider Demographics
NPI:1619149325
Name:JOSEPH, DEEPA MATHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:MATHEW
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5262
Mailing Address - Country:US
Mailing Address - Phone:630-204-5867
Mailing Address - Fax:
Practice Address - Street 1:1306 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-2703
Practice Address - Country:US
Practice Address - Phone:630-810-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005019827208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics