Healthcare Provider Details

I. General information

NPI: 1487709200
Provider Name (Legal Business Name): MATTHEW A FELGUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 ODANA RD. SUITE 106
MADISON WI
53719
US

IV. Provider business mailing address

6402 ODANA RD. SUITE 106
MADISON WI
53719
US

V. Phone/Fax

Practice location:
  • Phone: 608-257-1581
  • Fax: 608-257-1599
Mailing address:
  • Phone: 608-257-1581
  • Fax: 608-257-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number39227
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number39227
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39227
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: