Individual
DR. MATTHEW ROBERT VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8701 W WATERTOWN PLANK RD, POST OFFICE BOX 26509, MILWAUKEE, WI 53226
(414) 955-4575
(414) 955-6528
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
62730-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801139837
—
WI
Enumeration date
03/27/2013
Last updated
06/21/2018
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