Healthcare Provider Details

I. General information

NPI: 1285644328
Provider Name (Legal Business Name): MATTHEW D PUTNAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 SOUTH 7TH STREET SUITE R102, UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55454
US

IV. Provider business mailing address

2512 SOUTH 7TH STREET SUITE R102, UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55454
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-9400
  • Fax:
Mailing address:
  • Phone: 612-273-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32421
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number32421
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: