Healthcare Provider Details

I. General information

NPI: 1457739856
Provider Name (Legal Business Name): MATTHEW R DANZIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N 92ND ST STE 330
MILWAUKEE WI
53226-4875
US

IV. Provider business mailing address

999 N 92ND ST STE 330
MILWAUKEE WI
53226-4875
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6575
  • Fax: 303-724-2818
Mailing address:
  • Phone: 414-266-6575
  • Fax: 303-724-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number72788-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: