Provider Demographics
NPI:1528080900
Name:RICHLEN, MATTHEW M (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:RICHLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9252 N GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1104
Mailing Address - Country:US
Mailing Address - Phone:414-527-7500
Mailing Address - Fax:414-365-6320
Practice Address - Street 1:9252 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1104
Practice Address - Country:US
Practice Address - Phone:414-527-7500
Practice Address - Fax:414-365-6320
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47260-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34671800Medicaid
WII33588Medicare UPIN