Healthcare Provider Details

I. General information

NPI: 1376731018
Provider Name (Legal Business Name): MATT HELLMER H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 RICKMEYER DR SUITE CC
FOND DU LAC WI
54937-2213
US

IV. Provider business mailing address

140 CORPORATE DR SUITE 1
BEAVER DAM WI
53916-1281
US

V. Phone/Fax

Practice location:
  • Phone: 920-922-6640
  • Fax:
Mailing address:
  • Phone:
  • Fax: 920-887-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1183-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: