Provider Demographics
NPI:1184650103
Name:STONE, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STONE
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 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN503442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN960371044225OtherPREFERRED ONE
MN134505OtherUCARE
MN254525OtherMIDLANDS CHOICE
MN75S27STOtherBLUE CROSS AND BLUE SHEILD OF MINNESOTA
WI34942800Medicaid
MNHP76932OtherHEALTHPARTNERS
MN04891000Medicaid
MN46L57STOtherBLUE CROSS AND BLUE SHIELD OF MINNESOTA
WI006256135Medicare PIN
MNP00437109Medicare PIN
MN300004335Medicare PIN
MN960371044225OtherPREFERRED ONE
MN134505OtherUCARE
WI34942800Medicaid