Provider Demographics
NPI:1487637856
Name:MATTHEWS, H MARSHALL (MD)
Entity Type:Individual
Prefix:MR
First Name:H
Middle Name:MARSHALL
Last Name:MATTHEWS
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 1:1621 N TAYLOR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1990
Mailing Address - Country:US
Mailing Address - Phone:920-458-7433
Mailing Address - Fax:920-452-3594
Practice Address - Street 1:1621 N TAYLOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1990
Practice Address - Country:US
Practice Address - Phone:920-458-7433
Practice Address - Fax:920-452-3594
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27726207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31644700Medicaid
F33928Medicare UPIN
WIWI2773015Medicare PIN