MR. MICHAEL LEROY MATTESON (NPI# 1033386115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033386115 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL LEROY MATTESON |
| Credential | PA C |
| Practice Address |
305 W Jackson St Suite 105 Carbondale IL 62901-1474 |
| Mailing Address |
Po Box 1105 Indianapolis IN 46206-1105 |
| Practice Telephone | 6185362565 |
| Practice Fax Number | 6185362835 |
| Mailing Telephone | 6184575200 |
| Mailing Fax Number | 6183514821 |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2011-10-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
385000710 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
305 W JACKSON ST SUITE 105 |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-1474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871596726 | John Ward Watson | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 305 W Jackson St, Suite 105, Carbondale, IL 62901-1474 | 2005-05-24 |
| 1780034926 | Ahmed Sharif | Family Medicine | 305 W Jackson St, Carbondale, IL 62901-1474 | 2016-06-19 |
| 1548619406 | Jordan Wood | Family Medicine | 305 W Jackson St, Carbondale, IL 62901-1474 | 2016-06-10 |
| 1225499825 | Ashley Nicole Freeman | Nurse Practitioner | 305 W Jackson St, Ste 103, Carbondale, IL 62901 | 2016-03-10 |
| 1548625460 | Kasia Schaefer | Physical Medicine & Rehabilitation | 305 W Jackson St, Carbondale, IL 62901-1474 | 2015-12-18 |
| 1770966137 | Pamela Renee Milano | Family Medicine | 305 W Jackson St, Ste 200, Carbondale, IL 62901-1474 | 2015-07-02 |
| 1215319140 | Gritz Pierre | Family Medicine | 305 W Jackson St, 200, Carbondale, IL 62901-1474 | 2015-06-27 |
| 1154702116 | Nabeel Mohammed Siddiqui | Family Medicine | 305 W Jackson St, Suite 200, Carbondale, IL 62901-1474 | 2015-06-16 |
| 1992196752 | New Horizons Medical Associates, LLC | Obstetrics & Gynecology | 305 W Jackson St, Suite 100, Carbondale, IL 62901-1474 | 2015-02-13 |
| 1255747002 | Fariha Rub | Family Medicine | 305 W Jackson St, Suite 200, Carbondale, IL 62901-1474 | 2014-07-01 |
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|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477169522 | Priority Assist Pllc | Physician Assistant | 48 Glenda Ln, Plano, IL 60545-9652 | 2020-09-23 |
| 1154944478 | Diana Goldak | Physician Assistant | 3855 N Parkway Dr Apt 3a, Northbrook, IL 60062-7218 | 2020-05-20 |
| 1033742580 | Colleen Courtney | Physician Assistant | 218 S Driftwood Trl, Mchenry, IL 60050-5454 | 2020-02-12 |
| 1326678962 | Nina Kodros | Physician Assistant | 301 Madison St Ste 280, Joliet, IL 60435-6672 | 2020-01-23 |
| 1689218190 | Jennifer Richman | Physician Assistant | 1890 Silver Cross Blvd Ste 410, New Lenox, IL 60451-9547 | 2019-10-29 |
| 1710547625 | Nadia Khan | Physician Assistant | 4543 N Malden St Apt 1s, Chicago, IL 60640-5687 | 2019-06-13 |
| 1962065516 | Jorge Mantilla | Physician Assistant | 5540 N Kimball Ave Apt 3e, Chicago, IL 60625-4674 | 2019-04-18 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1770041949 | Laura Ann Ryan | Physician Assistant | 840 S Wood St Ste 417, Chicago, IL 60612-4325 | 2019-03-06 |
| 1548739782 | Helen Finke | Physician Assistant | 880 W Central Rd Ste 3300, Arlington Heights, IL 60005-2366 | 2018-11-16 |
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| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on MR. MICHAEL LEROY MATTESON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.