Provider Demographics
NPI:1457739856
Name:DANZIG, MATTHEW R (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:DANZIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:999 N 92ND ST STE 330
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4875
Mailing Address - Country:US
Mailing Address - Phone:414-266-6575
Mailing Address - Fax:303-724-2818
Practice Address - Street 1:999 N 92ND ST STE 330
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4875
Practice Address - Country:US
Practice Address - Phone:414-266-6575
Practice Address - Fax:303-724-2818
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI72788-202088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO900131596Medicaid