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NPI Code Detail

MEDICARE: MATTHEW T LARSEN D.P.M.

MEDICARE: MATTHEW T LARSEN D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist775WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24388570001OTHERWIDMERC REGION B CARRIER
3213E00000XOTHERTAXONOMY CODE

General Provider Information

NPI Number : 1417944737
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW T LARSEN D.P.M.
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 8400 WASHINGTON AVE
Second Line :
City : MOUNT PLEASANT
State : WI
Zip : 53406-3735
Country : US
Telephone Number : 262-884-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 01/06/2025

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