Provider Demographics
NPI:1023646619
Name:HOGAN, MATTHEW GEORGE LIND (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GEORGE LIND
Last Name:HOGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 WINGHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2968
Mailing Address - Country:US
Mailing Address - Phone:419-980-2208
Mailing Address - Fax:
Practice Address - Street 1:608 ERIE ST
Practice Address - Street 2:
Practice Address - City:ANTWERP
Practice Address - State:OH
Practice Address - Zip Code:45813-9465
Practice Address - Country:US
Practice Address - Phone:419-258-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015411207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine