Provider Demographics
NPI:1093856635
Name:WEINBERG, MATTHEW NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:NATHAN
Last Name:WEINBERG
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 1:721 AMERICAN AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-549-1516
Mailing Address - Fax:262-549-0648
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-549-1516
Practice Address - Fax:262-549-0648
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50504-20207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35136500Medicaid
0000868120Medicare NSC