Healthcare Provider Details

I. General information

NPI: 1427462985
Provider Name (Legal Business Name): KELLY A MATHES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY A HUNTER DO

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N GREEN BAY RD
NEENAH WI
54956-1954
US

IV. Provider business mailing address

333 N GREEN BAY RD
NEENAH WI
54956-1954
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-6088
  • Fax: 920-729-6484
Mailing address:
  • Phone: 920-729-6088
  • Fax: 920-729-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number67780-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: