Individual
MATTHEW R. THEADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 REDBIRD CIR, SUITE 200, DE PERE, WI 54115-7977
(920) 338-6820
(920) 338-6829
Mailing address
555 REDBIRD CIR, SUITE 200, DE PERE, WI 54115-7977
(920) 338-6820
(920) 338-6829
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
39636
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32447000
—
WI
Enumeration date
08/09/2006
Last updated
10/11/2011
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