Provider Demographics
NPI:1629028428
Name:MATHEW, DELLA (MD)
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DELLA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:12200 PARK CENTRAL DR STE 189
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2116
Mailing Address - Country:US
Mailing Address - Phone:972-239-5445
Mailing Address - Fax:469-729-6691
Practice Address - Street 1:150 W HALF DAY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6591
Practice Address - Country:US
Practice Address - Phone:847-955-1144
Practice Address - Fax:847-955-1166
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-109903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine