| Doctor Name: | JEREMY MATHENIA |
| NPI Number: | 1285910059 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | 085004144 |
| Business Practice Address: | 4241 Hwy 14 W Christopher, IL - 628220155 |
| Business Phone Number: | 6187242401 |
| Business Fax Number: | 6187244628 |
| Mailing Address: | Po Box 155, CHRISTOPHER |
| State: | IL |
| Postal Code: | 628220155 |
| Phone Number: | 6187242401 |
| Fax Number: | 6187244628 |
| NPI Enumeration Date: | 10/25/2011 |
| NPI Last Update Date: | 10/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085004144 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |