Individual
DR. MATTHEW THOMAS LISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 S PARK ST, MADISON, WI 53715-1375
(608) 287-2100
(608) 833-6932
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
50324-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34926700
—
WI
01
—
P00609990
RR MEDICARE
WI
Enumeration date
05/06/2007
Last updated
01/14/2021
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