Healthcare Provider Details

I. General information

NPI: 1609568237
Provider Name (Legal Business Name): MATTHEW WALTER MACIEJEWSKI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 HAKE ST
FORT ATKINSON WI
53538-1212
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-2136
  • Fax:
Mailing address:
  • Phone: 920-563-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1378-25
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: