Individual
MATTHEW T LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
8400 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3735
(262) 884-4000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
775
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213E00000X
TAXONOMY CODE
—
05
—
43226300
—
WI
01
—
4388570001
DMERC REGION B CARRIER
WI
Enumeration date
10/03/2005
Last updated
01/06/2025
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