Individual
MATTHEW RYAN PURCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(812) 243-9158
Mailing address
14 WISTERIA COURT, FOND DU LAC, WI 54937
(812) 243-9158
(262) 245-2248
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
66928-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100069020
—
WI
Enumeration date
03/17/2013
Last updated
04/30/2024
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