Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6479 | MN |
NPI | 1871110635 |
---|---|
Provider Name | Matthew Shem |
First Address | Minnetonka, MN 55305-1772 |
Second Address | Minnetonka, MN 55305-1772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2020 |
Last Update Date | 28/06/2020 |