Provider Demographics
NPI:1396036893
Name:HANSMEIER, MATTHEW MORRIS (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MORRIS
Last Name:HANSMEIER
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 1:4190 LOBERG AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2652
Mailing Address - Country:US
Mailing Address - Phone:218-249-5700
Mailing Address - Fax:218-249-4666
Practice Address - Street 1:475 CHIPPEWA MALL DR STE 418
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5047
Practice Address - Country:US
Practice Address - Phone:715-720-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1396036893OtherBCBS
MNP01099799OtherRR MEDICARE
0001-0100273OtherMEDICA
MN1396036893Medicaid
0001-0100273OtherMEDICA