Provider Demographics
NPI:1336116391
Name:BOENTE, MATTHEW P (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:BOENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2281
Mailing Address - Country:US
Mailing Address - Phone:952-928-2900
Mailing Address - Fax:952-928-2944
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE 210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2281
Practice Address - Country:US
Practice Address - Phone:952-928-2900
Practice Address - Fax:952-928-2944
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43370207VG0400X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1027340OtherPREFERREDONE
MN564142000Medicaid
MN529T1BOOtherBLUE CROSS BLUE SHIELD
MN0703893OtherMEDICA
MN151532OtherUCARE MN
MN1282470OtherAMERICA'S PPO
WI34056200Medicaid
MNHP32764OtherHEALTHPARTNERS
MNP00193161Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN0703893OtherMEDICA
MN151532OtherUCARE MN