Provider Demographics
NPI:1639158728
Name:PILDITCH, MATTHEW E (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:PILDITCH
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:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-0534
Mailing Address - Country:US
Mailing Address - Phone:630-734-0580
Mailing Address - Fax:630-734-0581
Practice Address - Street 1:3080 OGDEN AVE STE 204
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1694
Practice Address - Country:US
Practice Address - Phone:630-734-0580
Practice Address - Fax:630-734-0581
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615849OtherBCBS
IL036095425Medicaid
IL036095425Medicaid
IL01615849OtherBCBS