Provider Demographics
NPI:1275928624
Name:MATHEWS, NATHAN R (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:R
Last Name:MATHEWS
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 1:675 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1739
Mailing Address - Country:US
Mailing Address - Phone:262-763-7772
Mailing Address - Fax:262-763-7002
Practice Address - Street 1:675 W STATE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1739
Practice Address - Country:US
Practice Address - Phone:262-763-7613
Practice Address - Fax:262-947-4996
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68043-20207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100057672Medicaid