Provider Demographics
NPI:1972918894
Name:ABENDROTH, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ABENDROTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-1324
Mailing Address - Country:US
Mailing Address - Phone:515-434-3054
Mailing Address - Fax:515-497-4062
Practice Address - Street 1:3709 SOUTHERN HILLS DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-1324
Practice Address - Country:US
Practice Address - Phone:515-400-4865
Practice Address - Fax:515-497-4062
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10100207Q00000X
IADO-04750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine