Healthcare Provider Details

I. General information

NPI: 1306760574
Provider Name (Legal Business Name): MATTHEW HUXTABLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 MENDOTA RD
INVER GROVE HEIGHTS MN
55077-1256
US

IV. Provider business mailing address

1420 MENDOTA RD
INVER GROVE HEIGHTS MN
55077-1256
US

V. Phone/Fax

Practice location:
  • Phone: 651-455-9724
  • Fax:
Mailing address:
  • Phone: 651-455-9724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3014
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: