1639215197 NPI number — MR. MATTHEW J. ORZEL PA

Table of content: MR. MATTHEW J. ORZEL PA (NPI 1639215197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639215197 NPI number — MR. MATTHEW J. ORZEL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORZEL
Provider First Name:
MATTHEW
Provider Middle Name:
J.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1639215197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10001 W INNOVATION DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-4851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-771-6780
Provider Business Mailing Address Fax Number:
414-238-2424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 75TH STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PLEASANT PRAIRIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53158-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-771-6760
Provider Business Practice Location Address Fax Number:
414-238-2424
Provider Enumeration Date:
01/30/2007

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: 363AM0700X , with the licence number:  085002635 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 4751-23 , 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)





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