Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | OS9282 | FL |
N | 207X00000X | Orthopaedic Surgeon | 5101014350 | MI |
Y | 207X00000X | Orthopaedic Surgeon | 63648-21 | WI |
NPI | 1174528202 |
---|---|
Provider Name | Dr. Matthew Brendon Colligan |
First Address | Green Bay, WI 54303-3211 |
Second Address | Green Bay, WI 54303-3211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 26/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270390400 | (05) | FL |
4820631 | (05) | MI |
I15010 | (02) | FL |