Individual
MATTHEW R EVENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 WEST AVE S, LA CROSSE, WI 54601
(608) 785-0940
Mailing address
PO BOX 1510, EAU CLAIRE, WI 54702-1510
(608) 785-0940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
61435
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2012
Last updated
10/07/2020
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