Provider Demographics
NPI:1881684546
Name:MAUNU, MATTHEW L (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:MAUNU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:600 MT HIGHWAY 91 S
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-7379
Mailing Address - Country:US
Mailing Address - Phone:406-683-3000
Mailing Address - Fax:406-683-3027
Practice Address - Street 1:600 MT HIGHWAY 91 S
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-7379
Practice Address - Country:US
Practice Address - Phone:406-683-3000
Practice Address - Fax:406-683-3027
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44007208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114153OtherFIRST HEALTH PLAN
43F36MAOtherBLUE CROSS BLUE SHIELD
020049623OtherRR MEDICARE
151703OtherU CARE
986426100OtherMEDICAL ASSISTANCE
C11369OtherRR MEDICARE
1027346OtherPREFERRED ONE
1285221OtherARAZ GROUP AMERICAS PPO
1700538OtherMEDICA HEALTH PLANS
1285221OtherARAZ GROUP AMERICAS PPO
G57770Medicare UPIN