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NPI Code Detail

MEDICARE: DR. MATTHEW BRENDON COLLIGAN D.O.

MEDICARE: DR. MATTHEW BRENDON COLLIGAN D.O.
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
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) PhysicianOS9282FL
2207X00000XOrthopaedic Surgery Physician5101014350MI
3207X00000XOrthopaedic Surgery Physician63648-21WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174528202
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW BRENDON COLLIGAN D.O.
Provider Business Mailing Address
First Line : 1715 DOUSMAN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3211
Country : US
Telephone Number : 920-496-4700
Fax Number :
Provider Business Practice Location Address
First Line : 1715 DOUSMAN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3211
Country : US
Telephone Number : 920-496-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 03/26/2015

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Directions to “ DR. MATTHEW BRENDON COLLIGAN D.O.” Practice Location

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