Provider Demographics
NPI:1871795120
Name:MATISOFF, ANDREW JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JEFFREY
Last Name:MATISOFF
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-1019
Practice Address - Country:US
Practice Address - Phone:608-263-8100
Practice Address - Fax:608-262-6247
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0956207L00000X
WI5174-320207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC230573OtherMEDICARE GROUP NUMBER
TX8L2856Medicare PIN
NC2067038Medicare PIN