Healthcare Provider Details

I. General information

NPI: 1912983875
Provider Name (Legal Business Name): MATTHEW M HEBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 26TH ST
PRAIRIE DU SAC WI
53578-2203
US

IV. Provider business mailing address

260 26TH ST
PRAIRIE DU SAC WI
53578-2203
US

V. Phone/Fax

Practice location:
  • Phone: 608-643-2471
  • Fax: 608-643-4788
Mailing address:
  • Phone: 608-643-2471
  • Fax: 608-643-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number42368
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: