Provider Demographics
NPI:1215128079
Name:MATHEW, THERESA I (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:I
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 GRAND CANYON PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1739
Mailing Address - Country:US
Mailing Address - Phone:847-884-8420
Mailing Address - Fax:847-884-0198
Practice Address - Street 1:990 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1739
Practice Address - Country:US
Practice Address - Phone:847-884-8420
Practice Address - Fax:847-884-0198
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine