Individual
MR. MATHEW PATRICK HERBST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 S CENTURY AVE, WAUNAKEE, WI 53597
(608) 849-4315
(608) 850-1606
Mailing address
1100 DELAPLAINE CT, ATTN: EDUCATIONAL SERVICES, MADISON, WI 53715-1840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
66597-20
WI
225100000X
Physical Therapist
10762-024
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811020969
—
WI
Enumeration date
03/14/2007
Last updated
11/23/2020
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