Provider Demographics
NPI:1447367941
Name:YELLE, MATTHEW C (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:YELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4 DEERWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1253
Mailing Address - Country:US
Mailing Address - Phone:218-631-1360
Mailing Address - Fax:218-631-7571
Practice Address - Street 1:4 DEERWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1253
Practice Address - Country:US
Practice Address - Phone:218-631-1360
Practice Address - Fax:218-631-7571
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN31574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN347088100Medicaid
MN347088100Medicaid