Provider Demographics
NPI:1689317083
Name:ERBST, MATTHEW J
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:ERBST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 W WRIGHTWOOD AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2531
Mailing Address - Country:US
Mailing Address - Phone:707-591-1265
Mailing Address - Fax:
Practice Address - Street 1:644 W WRIGHTWOOD AVE APT 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2531
Practice Address - Country:US
Practice Address - Phone:707-591-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program