Provider Demographics
NPI:1316467053
Name:HUSTRULID, MATTHEW LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LEE
Last Name:HUSTRULID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR.
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3444
Mailing Address - Fax:319-384-8114
Practice Address - Street 1:2929 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7363
Practice Address - Country:US
Practice Address - Phone:605-342-2852
Practice Address - Fax:605-342-3930
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-110492085R0202X
SD142552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology