Provider Demographics
NPI:1295732295
Name:ULVEN, MATTHEW E (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:ULVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TRAER
Mailing Address - State:IA
Mailing Address - Zip Code:50675-1142
Mailing Address - Country:US
Mailing Address - Phone:319-272-3020
Mailing Address - Fax:319-478-2933
Practice Address - Street 1:200 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TRAER
Practice Address - State:IA
Practice Address - Zip Code:50675-1142
Practice Address - Country:US
Practice Address - Phone:319-272-3020
Practice Address - Fax:319-478-2933
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1986935Medicaid
7197356OtherAAFP ID#
7197356OtherAAFP ID#
IAI14970Medicare ID - Type UnspecifiedIOWA MEDICARE ID#