Basic Information
| Provider Information | |||||||||
| NPI: | 1184650103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STONE | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 50344 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 960371044225 | 01 | MN | PREFERRED ONE | OTHER | 134505 | 01 | MN | UCARE | OTHER | 254525 | 01 | MN | MIDLANDS CHOICE | OTHER | 75S27ST | 01 | MN | BLUE CROSS AND BLUE SHEILD OF MINNESOTA | OTHER | 34942800 | 05 | WI | MEDICAID | HP76932 | 01 | MN | HEALTHPARTNERS | OTHER | 04891000 | 05 | MN | MEDICAID | 46L57ST | 01 | MN | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | OTHER |