Provider Demographics
NPI:1891720678
Name:ANDRES, MATTHEW WADE (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WADE
Last Name:ANDRES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 NW 108TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-3729
Mailing Address - Country:US
Mailing Address - Phone:515-334-7524
Mailing Address - Fax:515-334-7528
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:MERCY MEDICAL CENTER PATHOLOGY DEPARTMENT
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2610
Practice Address - Country:US
Practice Address - Phone:515-247-3115
Practice Address - Fax:515-643-8911
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3678207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAAPPLIED FORMedicaid
IAAPPLIED FORMedicare ID - Type Unspecified
IAAPPLIED FORMedicare UPIN