Individual
MATT OETKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3916 N INTERTECH CT, APPLETON, WI 54913-6957
(920) 996-1000
Mailing address
3916 N INTERTECH CT, APPLETON, WI 54913-6957
(920) 996-1000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42343-021
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30098800
—
WI
Enumeration date
07/01/2006
Last updated
01/28/2014
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