Healthcare Provider Details

I. General information

NPI: 1316887730
Provider Name (Legal Business Name): FREDERIC BENJAMIN MATALON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 250
MILWAUKEE WI
53215-3678
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY STE 250
MILWAUKEE WI
53215-3678
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6732
  • Fax: 414-649-5840
Mailing address:
  • Phone: 414-649-6732
  • Fax: 414-649-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: