Provider Demographics
NPI:1033190624
Name:MATHEWS, VINCENT P (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:P
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-3750
Mailing Address - Fax:414-259-9290
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-3750
Practice Address - Fax:414-259-9290
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036675A2085R0202X
WI619342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN020170OtherSIHO-351158723
IN108061OtherHEALTH ALLIANCE-351158723
WI1033190624Medicaid
INQ0071557OtherCMOSHO351158723&352047427
IN300136991OtherRR MEDICARE-351158723
IN000000492358OtherANTHEM 203778927
IN200067870Medicaid
IN000000248977OtherANTHEM-351158723
IN020170OtherSIHO-351158723
IN108061OtherHEALTH ALLIANCE-351158723
IN026010DDDMedicare PIN