Basic Information
Provider Information
NPI: 1740675552
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WINTERTON
FirstName: MATTHEW
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4800 MAINE ST
Address2:  
City: QUINCY
State: IL
PostalCode: 623055875
CountryCode: US
TelephoneNumber: 2172231200
FaxNumber:  
Practice Location
Address1: 4800 MAINE ST
Address2:  
City: QUINCY
State: IL
PostalCode: 623055875
CountryCode: US
TelephoneNumber: 2172231200
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/30/2015
LastUpdateDate: 07/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X036.152065ILY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XS0106X036.152065ILN Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery

No ID Information.


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