MEDICARE: DR. ROBERT D MATTEUCCI D.P.M.

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	881025	WI
2	213ES0103X	Foot & Ankle Surgery Podiatrist	016005168	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164426763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D MATTEUCCI D.P.M.

Provider Business Mailing Address
First Line	:	8153 S 27TH ST
Second Line	:	SUITE 400
City	:	FRANKLIN
State	:	WI
Zip	:	53132-9549
Country	:	US
Telephone Number	:	414-761-0981
Fax Number	:	414-761-1614

Provider Business Practice Location Address
First Line	:	8153 S 27TH ST
Second Line	:	SUITE 400
City	:	FRANKLIN
State	:	WI
Zip	:	53132-9549
Country	:	US
Telephone Number	:	414-761-0981
Fax Number	:	414-761-1614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	05/05/2010

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