Matthew David Amidon, D.O.
Individual provider Active NPI Pediatrics Physician · Milwaukee, WI
NPI 1164834735 · NPPES record last updated Jul 28, 2020
Key facts
- NPI
- 1164834735
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 67233 (WI)
- Practice address
- 9000 W Wisconsin Ave
Milwaukee, WI 53226-4874 - Phone
- (414) 266-3360
- Fax
- (414) 266-3563
- NPI assigned
- May 29, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200806000119 | WI | Practitioner - Pediatric Medicine | 8729384771 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.064656 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Medical College of Wisconsin, Inc. | Current |
Accepting new patients | |
| Children'S Specialty Group, Inc. | Pediatrics | Current |
Accepting new patients |
Locations
8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100
9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625
Interoperability endpoints
- mamidon54865@direct.chw.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 125.064656 | IL | |
| Pediatrics Physician | 208000000X | 67233 | WI | Yes |
Addresses
Primary practice location
9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Mailing address
9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-3360
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164834735 | Medicaid | WI |
Other providers in Milwaukee, WI
- American Telepsychiatry, Inc.
- American United Transportation Group
- American Way Therapy Associates
- Americoach Specialized Transportation, LLC
- Margaret Amidei
- Ryan Feld Amidon
- Amillion Treasures Inc
- Melanie Tiffany Amini-Hajibashi
- Amirable Advocates LLC
- Amity Health Services
All providers in Milwaukee, WI · Pediatrics Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.