Provider Demographics
NPI:1689913337
Name:MATHES PODIATRY LTD.
Entity Type:Organization
Organization Name:MATHES PODIATRY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATHES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-636-4022
Mailing Address - Street 1:6311 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2201
Mailing Address - Country:US
Mailing Address - Phone:708-636-4022
Mailing Address - Fax:708-636-4105
Practice Address - Street 1:6311 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2201
Practice Address - Country:US
Practice Address - Phone:708-636-4022
Practice Address - Fax:708-636-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6735300002Medicare NSC