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NPI Code Detail

MEDICARE: DR. MATHEW J PULICKEN MD

MEDICARE: DR. MATHEW J PULICKEN 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
12084N0400XNeurology PhysicianMD13907RI
22084N0400XNeurology Physician984370NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
123127OTHERNVNEVADA LIC
21102512OTHERNVCAQH

General Provider Information

NPI Number : 1629231832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATHEW J PULICKEN MD
Provider Business Mailing Address
First Line : 1155 MILL ST # M14
Second Line :
City : RENO
State : NV
Zip : 89502-1576
Country : US
Telephone Number : 775-982-5262
Fax Number : 775-982-5496
Provider Business Practice Location Address
First Line : 75 PRINGLE WAY STE 401
Second Line :
City : RENO
State : NV
Zip : 89502-1476
Country : US
Telephone Number : 775-982-5000
Fax Number : 775-982-2973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2008
Last Update Date : 01/03/2023

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Directions to “ DR. MATHEW J PULICKEN MD” Practice Location

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