Provider Demographics
NPI:1023451689
Name:HALLANGER, MATTHEW AARON (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:HALLANGER
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 1:1300 ANNE ST NW
Mailing Address - Street 2:SANFORD BEMIDJI MEDICAL CENTER
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5103
Mailing Address - Country:US
Mailing Address - Phone:218-333-5519
Mailing Address - Fax:218-333-4961
Practice Address - Street 1:1300 ANNE ST NW
Practice Address - Street 2:SANFORD BEMIDJI MEDICAL CENTER
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5103
Practice Address - Country:US
Practice Address - Phone:218-333-5519
Practice Address - Fax:218-333-4961
Is Sole Proprietor?:No
Enumeration Date:2013-04-14
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH011648207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program