Provider Demographics
NPI:1649270224
Name:MACCUMBER, MATHEW W (MD)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:W
Last Name:MACCUMBER
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 1:11516 183RD PL STE SW
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9471
Mailing Address - Country:US
Mailing Address - Phone:708-877-1300
Mailing Address - Fax:708-596-8719
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:STE 400
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4265
Practice Address - Country:US
Practice Address - Phone:708-596-8710
Practice Address - Fax:708-596-9820
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093409207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093409Medicaid
IL180033953OtherRRMC
IL036093409Medicaid
ILL54841Medicare PIN