Provider Demographics
NPI:1801959705
Name:MATHEW, SAMUEL P (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:P
Last Name:MATHEW
Suffix:
Gender:
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:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0947
Mailing Address - Country:US
Mailing Address - Phone:708-206-0305
Mailing Address - Fax:708-206-0300
Practice Address - Street 1:14475 JOHN HUMPHREY DR STE 100
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6216
Practice Address - Country:US
Practice Address - Phone:708-206-0305
Practice Address - Fax:708-206-0300
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065418207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031603366OtherBCBS PIN
IL010025068OtherRAILROAD MEDICARE PIN
IL036065418Medicaid
IL036065418Medicaid
IL901890Medicare PIN