DR. ELYCIA R MATUSHIN


Address: 1020 W Broadway Ave, Minneapolis, MN 55411-2504
Phone: 6123028200

DR. ELYCIA R MATUSHIN (NPI# 1255698783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1255698783
Entity Type Individual
Full Name DR. ELYCIA R MATUSHIN
Credential M.D.
Practice Address 1020 W Broadway Ave
Minneapolis
MN 55411-2504
Mailing Address 800 Freeport Ave Nw
Elk River
MN 55330-2723
Practice Telephone 6123028200
Practice Fax Number 6123028275
Mailing Telephone (763) 581-5200
Mailing Fax Number 7635815201
Enumeration Date 2012-04-22
Last Update Date 2017-09-11
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine 56637 MN Allopathic & Osteopathic Physicians

Office Location

Street Address 1020 W BROADWAY AVE
City MINNEAPOLIS
State MN
Zip Code 55411-2504

Providers in the same location

NPI Name Taxonomy Address Enumeration
1851393672 Jean Yeung Moon Pharmacist 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2005-08-11
1114548666 Valerie Jing Young Student in an Organized Health Care Education/Training Program 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-05-06
1992325476 John Hugh Granville Ward Student in an Organized Health Care Education/Training Program 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-04-24
1891315636 Emily Lund Student in an Organized Health Care Education/Training Program 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-04-22
1295355378 Tara Anderson Student in an Organized Health Care Education/Training Program 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-04-20
1003436296 Ian G Latham Student in an Organized Health Care Education/Training Program 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-04-17
1326668500 Catherine Pang Student in an Organized Health Care Education/Training Program 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-04-17
1154941300 Darien Kinne Student in an Organized Health Care Education/Training Program 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-04-17
1720608003 Christopher John Jennen Student in an Organized Health Care Education/Training Program 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-04-16
1669091278 Athena Brindle Cannon Pharmacist 1020 W Broadway Ave, Minneapolis, MN 55411-2504 2020-04-14
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1477101483 Minnesota Mental Health Solutions Social Worker 1007 W Broadway Ave Ste 200, Minneapolis, MN 55411 2019-09-03
1154980233 Access Group Home LLC Home Health 1122 Upton Ave N, Minneapolis, MN 55411 2019-06-11
1780036202 Marcia Karen Powless Registered Nurse 2339 River Pointe Lane, Minneapolis, MN 55411 2016-07-08
1104287663 Abdikarim Abdille Contractor 521 Lyn Park Cir N, Minneapolis, MN 55411 2016-03-11
1962801399 Olu's Center Clinic/Center 1315 12th Ave N, Minneapolis, MN 55411 2014-08-21
1689086639 Claudia Alejandra Patino Gonzalez Student in an Organized Health Care Education/Training Program 1020 West Broadway Avenue, Minneapolis, MN 55411 2014-05-27
1306283445 Advanced Home Care Home Health 3000 Logan Ave N, Minneapolis, MN 55411 2013-05-30
1154766525 Bassim Samadani Birkland Student in an Organized Health Care Education/Training Program Broadway Clinic, 1020 West Broadway, Minneapolis, MN 55411 2013-04-30
1720354004 New Salem Metormorphosis Youth Program Counselor 2509 Bryant Ave North, Minneapolis, MN 55411 2012-03-30
1629387469 Apose Home Health 2806 Girard Ave. North, Minneapolis, MN 55411 2010-09-28
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Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1336594498 Jaimi Weber Family Medicine Mmc 381, 420 Delaware St. Se, Minneapolis, MN 55445 2016-04-26
1376906388 Sama Healthcare Family Medicine 2639 Nicollet Ave., Suite 130, Minneapolis, MN 55408 2016-03-29
1902209687 Elaine May Family Medicine 2861 Burnham Blvd, Minneapolis, MN 55416-4331 2014-10-08
1952741050 Gregory Olszewski Family Medicine 19 S 1st St Apt B2603, Minneapolis, MN 55401-1845 2013-07-03
1881940864 Isaac Milton Engholm Family Medicine 825 Nicollet Mall Ste 403, Minneapolis, MN 55402-2611 2012-07-27
1942572763 Neighborhood Healthsource Family Medicine 1015 4th Avenue North, Suite 201, Minneapolis, MN 55405-1178 2012-02-09
1225323371 Yun Chau Bernice Lee Family Medicine 2823 Dean Pkwy, Minneapolis, MN 55416-4401 2011-06-16
1730487208 Specialized Medical Response, LLC Family Medicine 401 Harding St Ne #100, Minneapolis, MN 55413 2011-03-08
1285930065 Allina Health System Family Medicine 3024 Snelling Ave S, Minneapolis, MN 55406-1911 2011-01-27
1013226844 Corban Health Care, Pllc Family Medicine 5141 36th Ave S, Minneapolis, MN 55417-1518 2010-09-28
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Competitor

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City MINNEAPOLIS
Zip Code 55411

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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