Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 336.113353 | IL |
NPI | 1851747794 |
---|---|
Provider Name | Matthew Gevelinger |
First Address | Mineral Point, WI 53565-8846 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2016 |
Last Update Date | 14/09/2020 |