Provider Demographics
NPI:1841774825
Name:HUGGINS, MATTHEW E
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:HUGGINS
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 1:4553 W 56TH ST APT 204C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5389
Mailing Address - Country:US
Mailing Address - Phone:773-606-1411
Mailing Address - Fax:
Practice Address - Street 1:4553 W 56TH ST APT 204C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5389
Practice Address - Country:US
Practice Address - Phone:773-606-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL006063520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist