| Shelley Boehm Mattia Md,adult Psychiatry, Llc | |
|
428 Doty St Green Bay WI 54301-4509 | |
| (920) 965-6768 | |
| (920) 965-6769 |
| Full Name | Shelley Boehm Mattia Md,adult Psychiatry, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 428 Doty St, Green Bay, Wisconsin |
| Authorized Official Name and Position | Shelley Kathryn Boehm Mattia (LICENSED PHYSICIAN) |
| Authorized Official Contact | 9202464925 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shelley Boehm Mattia Md,adult Psychiatry, Llc 428 Doty St Green Bay WI 54301-4509 Ph: (920) 965-6768 | Shelley Boehm Mattia Md,adult Psychiatry, Llc 428 Doty St Green Bay WI 54301-4509 Ph: (920) 965-6768 |
| NPI Number | 1427410992 |
|---|---|
| Provider Enumeration Date | 03/24/2016 |
| Last Update Date | 10/04/2016 |
| Medicare PECOS PAC ID | 7810294493 |
|---|---|
| Medicare Enrollment ID | O20160325000095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427410992 | NPI | - | NPPES |
| 32453500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 39641 (Wisconsin) | Primary |
| Provider Name | Shelley K Boehm Mattia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073662938 PECOS PAC ID: 9335272913 Enrollment ID: I20100803000689 |
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