Provider Demographics
NPI:1790007680
Name:MATZ, STEPHEN D (MS, CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:MATZ
Suffix:
Gender:M
Credentials:MS, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15225 GINGER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7303
Mailing Address - Country:US
Mailing Address - Phone:708-460-9706
Mailing Address - Fax:708-460-9706
Practice Address - Street 1:15225 GINGER CREEK LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7303
Practice Address - Country:US
Practice Address - Phone:708-460-9706
Practice Address - Fax:708-460-9706
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.002445367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL965410Medicare PIN