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Individual

DR. MATTHEW EDWARD BETTAG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1520 N MEADE ST, APPLETON, WI 54911-3762
(920) 734-7181
(920) 734-0621
Mailing address
2424 TREFOIL CT, MENASHA, WI 54952-8922
(920) 954-5624

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
44145
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
34184900
WI
Enumeration date
08/16/2005
Last updated
07/30/2012
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