Provider Demographics
NPI:1730124298
Name:KAMMERER, MATTHEW C (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:KAMMERER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4655
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND33213E00000X
MN544213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1H734KAOtherMNBS #
ND12927OtherNDBS #
ND13015OtherNDBS #
ND18310Medicaid
ND1H742KAOtherMNBS #
ND1H771KAOtherMNBS #
T83418OtherUPIN #
ND172027OtherUCARE #
ND680151OtherAMERICA'S PPO/ARAZ #
NDND200106OtherLHS #
ND313018500Medicaid
NDDA9051015612OtherPREFERRED ONE #
NDHP25786OtherHEALTHPARTNERS #
ND2700155OtherMEDICA #
MN489000199Medicare ID - Type UnspecifiedMN MEDICARE #
ND2700155OtherMEDICA #
ND680151OtherAMERICA'S PPO/ARAZ #
ND12927Medicare ID - Type UnspecifiedND MEDICARE #
T83418OtherUPIN #
ND13015OtherNDBS #