1477725547 NPI number — DR. MATTHEW RYAN DELUHERY M.D.

Table of content: DR. MATTHEW RYAN DELUHERY M.D. (NPI 1477725547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477725547 NPI number — DR. MATTHEW RYAN DELUHERY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELUHERY
Provider First Name:
MATTHEW
Provider Middle Name:
RYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477725547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 AMERICAN AVE
Provider Second Line Business Mailing Address:
EMERGENCY MEDICAL ASSOCIATES OF WAUKESHA
Provider Business Mailing Address City Name:
WAUKESHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53188-5031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-928-2475
Provider Business Mailing Address Fax Number:
262-928-5697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 AMERICAN AVE
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICAL ASSOCIATES OF WAUKESHA
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188-5031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-928-1000
Provider Business Practice Location Address Fax Number:
262-928-5697
Provider Enumeration Date:
03/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  53619-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)