Active NPI
Matthew Eugene Bantz, PHARMD
- Pharmacist
- Milwaukee, WI
National Provider Identifier
1578193744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16320
- Practice address
- 6901 W Edgerton Ave
Milwaukee, WI 53220-4420 - Phone
- (414) 421-8401
- Fax
- (414) 855-0748
- NPI assigned
- Jan 16, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 13
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17697 | AL | |
| Pharmacist | 183500000X | 1-106313 | KS | |
| Pharmacist | 183500000X | PST.021720 | LA | |
| Pharmacist | 183500000X | PH236166 | MA | |
| Pharmacist | 183500000X | 5302043341 | MI | |
| Pharmacist | 183500000X | 23906 | MD | |
| Pharmacist | 183500000X | T-15141 | MS | |
| Pharmacist | 183500000X | 14885 | NE | |
| Pharmacist | 183500000X | 16880 | OK | |
| Pharmacist | 183500000X | 59136 | TX | |
| Pharmacist | 183500000X | 033.0130667 | VT | |
| Pharmacist | 183500000X | RP0008529 | WV | |
| Pharmacist | 183500000X | 16320 | WI | Primary |
Addresses
Primary practice location
6901 W Edgerton Ave
Milwaukee, WI 53220-4420
Mailing address
6901 W Edgerton Ave
Milwaukee, WI 53220-4420
Phone (414) 421-8401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17697 | AL | MD | Pharmacist |
| 1-106313 | KS | MD | Pharmacist |
| PST.021720 | LA | MD | Pharmacist |
| PH236166 | MA | MD | Pharmacist |
| 5302043341 | MI | MD | Pharmacist |
| T-15141 | MS | MD | Pharmacist |
| 14885 | NE | MD | Pharmacist |
| 59136 | TX | MD | Pharmacist |
| 033.0130667 | VT | MD | Pharmacist |
| RP0008529 | WV | MD | Pharmacist |
| 16880 | OK | MD | Dermatology Physician |
| 16320 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579305600000",
"number": "1578193744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6901 W EDGERTON AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532204420",
"telephone_number": "414-421-8401",
"fax_number": "414-855-0748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6901 W EDGERTON AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532204420",
"telephone_number": "414-421-8401",
"fax_number": "414-855-0748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANTZ",
"first_name": "MATTHEW",
"middle_name": "EUGENE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-16",
"last_updated": "2020-01-18",
"certification_date": "2020-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "17697",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KS",
"license": "1-106313",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.021720",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH236166",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302043341",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "23906",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "T-15141",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NE",
"license": "14885",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "16880",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "59136",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VT",
"license": "033.0130667",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0008529",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "16320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.