Provider Demographics
NPI:1164426763
Name:MATTEUCCI, ROBERT D (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:MATTEUCCI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8153 S 27TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9549
Mailing Address - Country:US
Mailing Address - Phone:414-761-0981
Mailing Address - Fax:414-761-1614
Practice Address - Street 1:8153 S 27TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9549
Practice Address - Country:US
Practice Address - Phone:414-761-0981
Practice Address - Fax:414-761-1614
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI881025213ES0103X
IL016005168213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43237400Medicaid
WI1164426763Medicare NSC
V01175Medicare UPIN
WI000081059Medicare ID - Type Unspecified
WI43237400Medicaid