Provider Demographics
NPI:1679934210
Name:RESNICK, MATHEW (DO)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:RESNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1735
Mailing Address - Country:US
Mailing Address - Phone:630-291-6024
Mailing Address - Fax:
Practice Address - Street 1:499 BLACKHAWK DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1735
Practice Address - Country:US
Practice Address - Phone:630-291-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program