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NPI Code Detail

MEDICARE: DR. MATTHEW PAUL NELSON D.O.

MEDICARE: DR. MATTHEW PAUL NELSON D.O.
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
1207P00000XEmergency Medicine PhysicianOS013189PA
2207P00000XEmergency Medicine Physician57397-21WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00409100OTHERPARAILROAD MEDICARE
4P01099948OTHERWIMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001753894OTHERPABLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720030422
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW PAUL NELSON D.O.
Provider Business Mailing Address
First Line : 3 NEENAH CTR
Second Line :
City : NEENAH
State : WI
Zip : 54956-3070
Country : US
Telephone Number : 715-258-1000
Fax Number :
Provider Business Practice Location Address
First Line : 800 RIVERSIDE DR
Second Line :
City : WAUPACA
State : WI
Zip : 54981-1943
Country : US
Telephone Number : 715-258-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 05/05/2022

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