FIDEL MATA

DECATUR, IL
NPI1558445924
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: IL  085-002235)
Additional Taxonomies207RC0000X Internal Medicine, Cardiovascular Disease
(Licence: IL  085.002235)
Enumeration Date2006-10-24
Last Update Date2021-12-20
Business Address
FIDEL MATA P.A.
1770 E LAKE SHORE DR STE 105
DECATUR, IL 62521-3800
Phone number: 217-422-6100
Mailing Address
FIDEL MATA P.A.
1770 E LAKE SHORE DR STE 105
DECATUR, IL 62521-3800
Phone number: 217-422-6100