Provider Demographics
NPI:1790771517
Name:GOLDBLATT, MATTHEW ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ISAAC
Last Name:GOLDBLATT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5727
Mailing Address - Fax:414-454-0152
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5727
Practice Address - Fax:414-454-0152
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-11-22
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Provider Licenses
StateLicense IDTaxonomies
WI40134-20208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1790771517Medicaid