Healthcare Provider Details

I. General information

NPI: 1841230208
Provider Name (Legal Business Name): MATTHIAS A. FUCHS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 S WEBSTER AVE 2ND FLOOR
GREEN BAY WI
54301-3505
US

IV. Provider business mailing address

744 S WEBSTER AVE 2ND FLOOR
GREEN BAY WI
54301-3505
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3640
  • Fax: 920-433-3716
Mailing address:
  • Phone: 920-433-3640
  • Fax: 920-433-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19777-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: