Provider Demographics
NPI:1689374548
Name:MEIER, MATTHEW MCGRAW
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MCGRAW
Last Name:MEIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22901 AMBASSADOR BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-9312
Mailing Address - Country:US
Mailing Address - Phone:763-242-7583
Mailing Address - Fax:
Practice Address - Street 1:22901 AMBASSADOR BLVD NW
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-9312
Practice Address - Country:US
Practice Address - Phone:763-242-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier