Provider Demographics
NPI:1053081000
Name:BAERTLEIN, MATTHEW ALAN
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:BAERTLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 99TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55808-1907
Mailing Address - Country:US
Mailing Address - Phone:507-269-4152
Mailing Address - Fax:
Practice Address - Street 1:610 99TH AVE W
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55808-1907
Practice Address - Country:US
Practice Address - Phone:507-269-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant