Provider Demographics
NPI:1770640880
Name:MATHEW, ABRAHAM P (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:P
Last Name:MATHEW
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 1:3330 W 177TH ST STE 1G
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2186
Mailing Address - Country:US
Mailing Address - Phone:708-687-5400
Mailing Address - Fax:708-960-4159
Practice Address - Street 1:3330 W 177TH ST STE 1G
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2186
Practice Address - Country:US
Practice Address - Phone:708-687-5400
Practice Address - Fax:708-960-4159
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088194Medicaid
ILL76943Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER