Provider Demographics
NPI:1164477824
Name:MUNDING, MATTHEW D (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:MUNDING
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 1:5751 MEADOW VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6602
Mailing Address - Country:US
Mailing Address - Phone:406-531-6952
Mailing Address - Fax:
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:SUTIE 301
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7420
Practice Address - Country:US
Practice Address - Phone:406-926-6999
Practice Address - Fax:406-926-6999
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9973208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1164477824Medicaid
MTM000009917OtherMEDICARE GROUP
MT0000912100OtherBCBSMT
H58772Medicare UPIN
MTM011000139Medicare PIN