Individual
MATTHEW T. DUPRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
714 N MICHIGAN ST, SOUTH BEND, IN 46601-1035
(574) 647-7477
(574) 647-3655
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01074490A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
162520068
MEDICARE PTAN
IN
05
—
201107460
—
IN
Enumeration date
05/21/2012
Last updated
04/01/2021
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