Provider Demographics
NPI:1013123058
Name:WEICHBRODT, MATTHEW THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:WEICHBRODT
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 1:18444 N 25TH AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:10494 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3058
Practice Address - Country:US
Practice Address - Phone:623-537-5600
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4744207X00000X, 207XX0801X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ321626Medicaid
AZ5550830008OtherMEDICARE NSC SWV
AZ5550830004OtherMEDICARE NSC PV
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ5550830007OtherMEDICARE NSC DV
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830010OtherMEDICARE NSC GILBERT
AZP00688674OtherRR MEDICARE
AZ321626Medicaid