Andersen, Matthew Robert

Andersen, Matthew Robert is an individual health care provider with primary practice located at 6948 W Windsor Ave , Berwyn IL 60402-3335. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Andersen, Matthew Robert can be contacted via phone (708) 749-4617.

Contact Information

Primary practice address
6948 W Windsor Ave Berwyn IL 60402-3335
Phone: (708) 749-4617
Fax: (708) 749-0094
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 036114336 Illinois

Profile Details

NPI number 1265637623
LBN Legal business name Andersen, Matthew Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 18th, 2007
Last updated Jan 24th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265637623 NPPES
Illinois MEDICAID 036 114336

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