Healthcare Provider Details

I. General information

NPI: 1306075742
Provider Name (Legal Business Name): MATTHEW W BEUCHEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 W JEFFERSON BLVD
FORT WAYNE IN
46804-4133
US

IV. Provider business mailing address

PO BOX 2526
FORT WAYNE IN
46801-2526
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-8686
  • Fax: 260-436-8585
Mailing address:
  • Phone: 260-436-8686
  • Fax: 260-436-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60440572
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01075091A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD60440572
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number01075091A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: