Provider Demographics
NPI:1902337447
Name:SPENCE, MATTHEW CORY (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CORY
Last Name:SPENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2530 CHICAGO AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4387
Mailing Address - Country:US
Mailing Address - Phone:612-813-3300
Mailing Address - Fax:612-813-3349
Practice Address - Street 1:2530 CHICAGO AVE STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4387
Practice Address - Country:US
Practice Address - Phone:612-813-3300
Practice Address - Fax:612-813-3349
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303481208000000X
MN76557208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics