Healthcare Provider Details

I. General information

NPI: 1528398526
Provider Name (Legal Business Name): MATTHEW ALBERT MCGEE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 04/13/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

IV. Provider business mailing address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

V. Phone/Fax

Practice location:
  • Phone: 218-634-2120
  • Fax:
Mailing address:
  • Phone: 218-634-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11073
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: