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General NPI Number Information
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NPI Number | 1972738615
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Entity Type | Individual
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Provider Name | MATTHEW J. BOARDMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 1821 S STOUGHTON RD
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City | MADISON
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State | WI
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Zip | 53716-2257
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Country | US
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Telephone | 608-260-6000
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Fax | 608-260-6699
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Provider Business Mailing Address
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Address Line | 1821 S STOUGHTON RD
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City | MADISON
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State | WI
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Zip | 53716-2257
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Country | US
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Telephone | 608-260-6000
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Fax | 608-260-6699
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 57622-021
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 57622-021
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number | 57622-021
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License Number State | WI
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