Healthcare Provider Details

I. General information

NPI: 1881684546
Provider Name (Legal Business Name): MATTHEW L MAUNU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

IV. Provider business mailing address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

V. Phone/Fax

Practice location:
  • Phone: 701-842-3000
  • Fax: 701-842-6248
Mailing address:
  • Phone: 701-842-3000
  • Fax: 701-842-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number44007
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23976
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: