Provider Demographics
NPI:1922242049
Name:MATHELIER, AMEDEE CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:AMEDEE
Middle Name:CHARLES
Last Name:MATHELIER
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 1:13602 ARROWHEAD COURT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-403-9569
Mailing Address - Fax:708-403-9569
Practice Address - Street 1:13602 ARROWHEAD COURT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-403-9569
Practice Address - Fax:708-403-9569
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-43655207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL44001580041Medicaid
AM3907271OtherDEA
IL460691Medicare PIN
ILC41481Medicare UPIN