Healthcare Provider Details

I. General information

NPI: 1851622492
Provider Name (Legal Business Name): MATTHEW MICHAEL MOREL CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E RIVER PARKWAY SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
MINNEAPOLIS MN
55414-3604
US

IV. Provider business mailing address

P.O. BOX 209036 SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
DALLAS TX
75320-9036
US

V. Phone/Fax

Practice location:
  • Phone: 612-596-6100
  • Fax: 612-330-5954
Mailing address:
  • Phone: 813-281-8478
  • Fax: 813-281-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: