Provider Demographics
NPI:1386692804
Name:MATHEWS, BIJU T (MD)
Entity type:Individual
Prefix:DR
First Name:BIJU
Middle Name:T
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2152
Mailing Address - Country:US
Mailing Address - Phone:321-383-7600
Mailing Address - Fax:321-383-8111
Practice Address - Street 1:605 N WASHINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2152
Practice Address - Country:US
Practice Address - Phone:321-383-7600
Practice Address - Fax:321-383-8111
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89508207RI0011X
FLME89508207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2676401-00Medicaid
FL2676401-00Medicaid
FL43274YMedicare PIN
FL43274WMedicare PIN
FL43274XMedicare PIN