Provider Demographics
NPI:1285644328
Name:PUTNAM, MATTHEW D (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:PUTNAM
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 1:2512 SOUTH 7TH STREET
Mailing Address - Street 2:SUITE R102, UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-273-9400
Mailing Address - Fax:
Practice Address - Street 1:2512 SOUTH 7TH STREET
Practice Address - Street 2:SUITE R102, UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32421207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0925136OtherMEDICA CHOICE
1009276OtherPREFERREDONE
101544OtherUCARE
IA1978577Medicaid
WI31478800Medicaid
HP16991OtherHEALTHPARTNERS
09-74783OtherMEDICA PRIMARY
23990OtherARAZ
MN2T391PUOtherBLUECROSS BLUESHIELD
MN039593500Medicaid
1009276OtherPREFERREDONE
101544OtherUCARE
WI31478800Medicaid