Basic Information
| Provider Information | |||||||||
| NPI: | 1740323617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | BINU | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 WILSON AVE | ||||||||
| Address2: | |||||||||
| City: | KIRKWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631222648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438450434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 621 S BALLAS RD | ||||||||
| Address2: | SUITE 3016 B | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142516339 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 08/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P18487 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.