Provider Demographics
NPI:1295909539
Name:ANDRESEN, MATTHEW CARL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CARL
Last Name:ANDRESEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18200 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5605
Mailing Address - Country:US
Mailing Address - Phone:216-476-7086
Mailing Address - Fax:216-476-7604
Practice Address - Street 1:18200 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5605
Practice Address - Country:US
Practice Address - Phone:216-476-7086
Practice Address - Fax:216-476-7604
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine