Matthew Mittelbronn, MD MPH

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MATTHEW MITTELBRONN, MD MPH

Doing business as

Lakeview Dermatology

Practice address

3918 Telephone Rd Ste 100
Lake Worth, TX 76135-2933

Phone

(817) 752-5256

NPI assigned

Sep 10, 2018

Last updated

Dec 17, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Mittelbronn, MD

Title

Owner

Phone

(504) 813-3318

Specialties & licenses 1

Addresses

Other names 1

• Lakeview Dermatology Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1093298762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5608 MALVEY AVE STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761075107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3918 TELEPHONE RD STE 100",
            "city": "LAKE WORTH",
            "state": "TX",
            "postal_code": "761352933",
            "telephone_number": "817-752-5256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW MITTELBRONN, MD MPH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-10",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "MITTELBRONN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-813-3318",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeview Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeview Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anthony Lynn Luedicke, RPH
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• Erica Martineau
• Michelle McGhee, RN
• Michael D. Conte PC (Lake Worth Vision Source)
• Corbin David Milenbaugh, DDS
• Mint Dentistry, PLLC (Lake Worth Mint Dentistry)
• Shannen Marcie Mitchell, HIS

• Dermatology Physician in Lake Worth, TX
• Providers in Lake Worth, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.