Provider Demographics
NPI:1194253484
Name:MAVES, MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MAVES
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 1:7861 STATE ROAD 60
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9305
Mailing Address - Country:US
Mailing Address - Phone:262-546-1050
Mailing Address - Fax:262-546-1051
Practice Address - Street 1:7861 STATE ROAD 60
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9305
Practice Address - Country:US
Practice Address - Phone:262-546-1050
Practice Address - Fax:262-546-1051
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0000047617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1194253484Medicaid