Provider Demographics
NPI:1992933204
Name:MATHEW, GINA ANN (DO)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:ANN
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 W VAN BUREN ST
Mailing Address - Street 2:UNIT # 418
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3588
Mailing Address - Country:US
Mailing Address - Phone:312-720-2521
Mailing Address - Fax:
Practice Address - Street 1:1339 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1836
Practice Address - Country:US
Practice Address - Phone:630-930-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132961208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics