Provider Demographics
NPI:1780644526
Name:HUMMEL, MATTHEW JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16838 E PALISADES BLVD
Mailing Address - Street 2:C153
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3786
Mailing Address - Country:US
Mailing Address - Phone:480-816-3131
Mailing Address - Fax:480-816-3136
Practice Address - Street 1:16838 E PALISADES BLVD
Practice Address - Street 2:C153
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3786
Practice Address - Country:US
Practice Address - Phone:480-816-3131
Practice Address - Fax:480-816-3136
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG94866Medicare UPIN