Provider Demographics
NPI:1023090560
Name:MATHUR, ARPANA BROOR (MD)
Entity type:Individual
Prefix:DR
First Name:ARPANA
Middle Name:BROOR
Last Name:MATHUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARPANA
Other - Middle Name:
Other - Last Name:BROOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:698 FEATHERSTONE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6303
Mailing Address - Country:US
Mailing Address - Phone:815-399-4404
Mailing Address - Fax:815-484-7091
Practice Address - Street 1:698 FEATHERSTONE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6303
Practice Address - Country:US
Practice Address - Phone:815-399-4404
Practice Address - Fax:815-484-7091
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336074258OtherIL STATE CTL SUBS LICENSE
IL553180OtherMEDICARE GROUP PTAN
IL834370OtherMEDICARE GROUP
IL036113594OtherIL STATE LICENSE
IL036113594Medicaid
IL0-551-903-8OtherECFMG NUMBER
IL0-551-903-8OtherECFMG NUMBER
ILK18300Medicare ID - Type UnspecifiedMEDICARE PROV ID# ROC
ILR01690Medicare PIN
ILBB9280429OtherDEA
IL036113594OtherIL STATE LICENSE
IL553180OtherMEDICARE GROUP PTAN
ILK18301Medicare ID - Type UnspecifiedMEDICARE PROV ID# BEL
IL0-551-903-8OtherECFMG NUMBER
ILK27899Medicare ID - Type Unspecified
IL036113594Medicaid
ILI31503Medicare UPIN
ILCC5050Medicare ID - Type UnspecifiedRR GROUP #
ILK18298Medicare ID - Type UnspecifiedMEDICARE PROV ID# FHC
ILK18299Medicare ID - Type UnspecifiedMEDICARE PROV ID# MTM