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NPI Code Detail

MEDICARE: MATTHEW NOLAN MD

MEDICARE: MATTHEW NOLAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RP1001XPulmonary Disease Physician56663MN

General Provider Information

NPI Number : 1043574007
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW NOLAN MD
Provider Business Mailing Address
First Line : 2800 CAMPUS DR STE 10
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2669
Country : US
Telephone Number : 763-520-2940
Fax Number :
Provider Business Practice Location Address
First Line : 3366 OAKDALE AVE N STE 401
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2986
Country : US
Telephone Number : 763-520-2940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2012
Last Update Date : 09/20/2022

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