Basic Information
Provider Information
NPI: 1497052021
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARMELINK
FirstName: MATTHEW
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 9000 W WISCONSIN AVE
Address2: PEDIATRIC NEUROLOGY
City: MILWAUKEE
State: WI
PostalCode: 532264874
CountryCode: US
TelephoneNumber: 4142663464
FaxNumber: 4142663466
Practice Location
Address1: 9000 W WISCONSIN AVE
Address2: PEDIATRIC NEUROLOGY
City: MILWAUKEE
State: WI
PostalCode: 532264874
CountryCode: US
TelephoneNumber: 4142663464
FaxNumber: 4142663466
Other Information
ProviderEnumerationDate: 02/16/2011
LastUpdateDate: 06/16/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XA114128CAN Allopathic & Osteopathic PhysiciansPediatrics 
2084N0402X57227WIY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology

No ID Information.


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