Doctor Name: | MATTHEW RODRIDGO ENDARA |
NPI Number: | 1033370937 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 036.134420 |
Business Practice Address: | 823 N 129th Infantry Dr Joliet, IL - 604358346 |
Business Phone Number: | 8157299527 |
Business Fax Number: | |
Mailing Address: | 5623 N Newcastle Ave, CHICAGO |
State: | IL |
Postal Code: | 606313145 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/23/2008 |
NPI Last Update Date: | 06/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2086S0122X |
License Number: | 036.134420 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Surgery |
Taxonomy Specialization: | Plastic and Reconstructive Surgery |
Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |